1952386393 NPI number — DAVID C JACOBS MD

Table of content: DAVID C JACOBS MD (NPI 1952386393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952386393 NPI number — DAVID C JACOBS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBS
Provider First Name:
DAVID
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1952386393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 GREAT CIRCLE RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37228-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-222-6977
Provider Business Mailing Address Fax Number:
615-222-5322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4220 HARDING RD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-222-6977
Provider Business Practice Location Address Fax Number:
615-222-5322
Provider Enumeration Date:
12/08/2005

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: 207R00000X , with the licence number:  37385 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 37385 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 37385 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 6010930 . This is a "BLUE CROSS-BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 38874641 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4154142 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3887464 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100052260 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4064306 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0007460476 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00400975 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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