1295206894 NPI number — MEREDITH PAIGE MCCAULEY

Table of content: MEREDITH PAIGE MCCAULEY (NPI 1295206894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295206894 NPI number — MEREDITH PAIGE MCCAULEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCAULEY
Provider First Name:
MEREDITH
Provider Middle Name:
PAIGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1295206894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 LAKE FOREST PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40245-4665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-681-2159
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 NATIONAL DR
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:
37128-6860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-898-0400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2018

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: 103K00000X , with the licence number:  RBT-18-53022 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: YRP955M64650 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".