1205896420 NPI number — MR. RANDALL JAMES BRILEY M.D.

Table of content: MR. RANDALL JAMES BRILEY M.D. (NPI 1205896420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205896420 NPI number — MR. RANDALL JAMES BRILEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRILEY
Provider First Name:
RANDALL
Provider Middle Name:
JAMES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1205896420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1069
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37116-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-868-1266
Provider Business Mailing Address Fax Number:
615-868-1316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 N. HIGHLAND AVENUE
Provider Second Line Business Practice Location Address:
MIDDLE TN MEDICAL CENTER
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-396-4489
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2006

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: 207ZP0105X , with the licence number:  25282 , 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: 3049004 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3083843 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".