1861655599 NPI number — METHODIST SPECIALTY PHYSICIAN, V, LLC

Table of content: (NPI 1861655599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861655599 NPI number — METHODIST SPECIALTY PHYSICIAN, V, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METHODIST SPECIALTY PHYSICIAN, V, LLC
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:
MCGEE GENERAL SURGERY CLINIC
Provider Other Organization Name Type Code:
3
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:
1861655599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 LAKEVIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38068-9737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-465-3604
Provider Business Mailing Address Fax Number:
901-465-4576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 LAKEVIEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38068-9737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-465-3604
Provider Business Practice Location Address Fax Number:
901-465-4576
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
KAY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
DIRECTOR OF PRACTICE DEVELOPMENT
Authorized Official Telephone Number:
901-516-0843

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  44014 , 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)





Copyright © 2007-2024 www.npivalidator.com