1982691812 NPI number — DR. FRANCES DICKSON BYNUM O.D.

Table of content: VIVIAN DUKES (NPI 1891288734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982691812 NPI number — DR. FRANCES DICKSON BYNUM O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYNUM
Provider First Name:
FRANCES
Provider Middle Name:
DICKSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

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:
1982691812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 HIGHWAY 431
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARTIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38237-8264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-587-2022
Provider Business Mailing Address Fax Number:
731-587-9397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 HIGHWAY 431
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38237-8264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-587-2022
Provider Business Practice Location Address Fax Number:
731-587-9397
Provider Enumeration Date:
10/05/2005

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: 152W00000X , with the licence number:  TN1767 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: OP0002996 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3153049 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3590029 . This is a "NEW MEDICARE PTAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4030100001 . This is a "PALMETTO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 410033713 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 6416 . This is a "TLC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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