1134233729 NPI number — MR. WILLIAM P FLOWERS JR. CRNA

Table of content: MR. WILLIAM P FLOWERS JR. CRNA (NPI 1134233729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134233729 NPI number — MR. WILLIAM P FLOWERS JR. CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLOWERS
Provider First Name:
WILLIAM
Provider Middle Name:
P
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
CRNA
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:
1134233729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
965 RIDGE LAKE BLVD STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38120-9446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-226-3186
Provider Business Mailing Address Fax Number:
901-578-2572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 HUMPHREYS CENTER DR STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38120-2353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-761-3900
Provider Business Practice Location Address Fax Number:
901-578-2572
Provider Enumeration Date:
08/19/2006

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: 163W00000X , with the licence number:  RN 63803 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 168219 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: APN 9282 , 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: 168025001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36206501 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000774419E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4216772 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00609674 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 07378790 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com