1831236652 NPI number — PATH LAB OF MIDDLE TENNESSEE

Table of content: (NPI 1831236652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831236652 NPI number — PATH LAB OF MIDDLE TENNESSEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATH LAB OF MIDDLE TENNESSEE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831236652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1069
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37116-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-868-1266
Provider Business Mailing Address Fax Number:
615-868-1316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 N HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37130-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-396-4489
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MICHAELSON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
D
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
615-396-4489

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25282 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2006591 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 220015692 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3032197 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3083843 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220015757 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3049004 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com