1972080257 NPI number — RIGHT TRACK MEDICAL GROUP, INC

Table of content: (NPI 1972080257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972080257 NPI number — RIGHT TRACK MEDICAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIGHT TRACK MEDICAL GROUP, INC
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:
1972080257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/26/2021
NPI Reactivation Date:
03/15/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 306600
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:
37230-6600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-234-7601
Provider Business Mailing Address Fax Number:
662-234-8531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9035 E SANDIDGE RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLIVE BRANCH
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38654-3563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-234-7601
Provider Business Practice Location Address Fax Number:
662-234-8531
Provider Enumeration Date:
07/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GLAVESKAS
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
214-550-7536

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  21831 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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