1174518104 NPI number — MRS. KARYNTHIA A PHILLIPS MSM,PA-C

Table of content: MRS. KARYNTHIA A PHILLIPS MSM,PA-C (NPI 1174518104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174518104 NPI number — MRS. KARYNTHIA A PHILLIPS MSM,PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
KARYNTHIA
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSM,PA-C
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:
1174518104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2275 MURFREESBORO PIKE
Provider Second Line Business Mailing Address:
SUITE 109-110
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37217-3341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-833-6898
Provider Business Mailing Address Fax Number:
615-833-6895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2275 MURFREESBORO PIKE
Provider Second Line Business Practice Location Address:
SUITE 109-110
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37217-3341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-833-6898
Provider Business Practice Location Address Fax Number:
615-833-6895
Provider Enumeration Date:
09/15/2005

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: 363AM0700X , with the licence number:  PA841 , 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: 36692701 . This is a "MEDICARE OTHER TULLAHOMA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 36692701 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: TN0101 . This is a "TULLAHOMA AMERICHOICE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1174518104 . This is a "NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3669270 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36692701 . This is a "TULLAHOMA MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4044007 . This is a "DUE WEST BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4137131 . This is a "DUE WEST BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4144463 . This is a "TULLAHOMA BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3669274 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4131037 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3669274 . This is a "MEDICARE OTHER DUE WEST" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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