1053427187 NPI number — MICHAEL BLAINE LENHART MD

Table of content: DR. DAVID J STARLING DMD (NPI 1760679237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053427187 NPI number — MICHAEL BLAINE LENHART MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENHART
Provider First Name:
MICHAEL
Provider Middle Name:
BLAINE
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:
1053427187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
228 WEST 4TH ST
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:
38501-2489
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 WEST 4TH ST
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:
08/22/2006

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: 207RC0000X , with the licence number:  MD26635 , 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: 0101044023 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3091395 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4288920 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 64929425 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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