1902009616 NPI number — DENNIS T MCWEENEY DO

Table of content: DENNIS T MCWEENEY DO (NPI 1902009616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902009616 NPI number — DENNIS T MCWEENEY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCWEENEY
Provider First Name:
DENNIS
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1902009616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3841 GREEN HILLS VILLAGE DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-2691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-936-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1161 21ST AVE S
Provider Second Line Business Practice Location Address:
B1100 MCN
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-343-6275
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X , with the licence number:  49811 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 474150000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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