1205832797 NPI number — COUNTY OF RUTHERFORD OFFICE OF BUDGET DIRECTOR

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205832797 NPI number — COUNTY OF RUTHERFORD OFFICE OF BUDGET DIRECTOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF RUTHERFORD OFFICE OF BUDGET DIRECTOR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1205832797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 E. LYTLE ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-217-0064
Provider Business Mailing Address Fax Number:
615-898-7952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 E LYTLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37130-3919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-898-7790
Provider Business Practice Location Address Fax Number:
615-898-7952
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DAVENPORT
Authorized Official First Name:
KACY
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
MEDICAL COMPLIANCE OFFICER
Authorized Official Telephone Number:
615-898-7790

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  EMS0000007501 , 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: 1401514 . This is a "HEALTHSPRING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 9852 . This is a "BLUE CROSS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 01040561 . This is a "AMERIGROUP COMMUNITY CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3524565 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590101329 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com