1285695858 NPI number — DR. YOUSSEF TAWFIK M.D.

Table of content: DR. YOUSSEF TAWFIK M.D. (NPI 1285695858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285695858 NPI number — DR. YOUSSEF TAWFIK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAWFIK
Provider First Name:
YOUSSEF
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1285695858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 BELL ROAD
Provider Second Line Business Mailing Address:
ANBA ABRAAM MEDICAL CLINIC
Provider Business Mailing Address City Name:
ANTIOCH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-365-9994
Provider Business Mailing Address Fax Number:
615-365-3443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 BELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTIOCH
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37013-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-365-9994
Provider Business Practice Location Address Fax Number:
615-365-3443
Provider Enumeration Date:
03/31/2006

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: 207R00000X , with the licence number:  9600750 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 44D2033773 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10341117166 . This is a "PTAN NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4314797 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1409706 . This is a "UHC PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1610088 . This is a "AMERIGROUP PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1525906 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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