1033376595 NPI number — SCOTT F REISING MD

Table of content: SCOTT F REISING MD (NPI 1033376595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033376595 NPI number — SCOTT F REISING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REISING
Provider First Name:
SCOTT
Provider Middle Name:
F
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:
1033376595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
228 W. 4TH STREET
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
COOKEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-372-0405
Provider Business Mailing Address Fax Number:
931-372-0463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 W. 4TH STREET
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
COOKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-372-0405
Provider Business Practice Location Address Fax Number:
931-372-0463
Provider Enumeration Date:
05/21/2008

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:  47573 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: MD47573 , 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)

  • Identifier: 4310402 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1524849 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100231230 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com