1336779974 NPI number — VERDI ONCOLOGY TENNESSEE, PC

Table of content: (NPI 1336779974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336779974 NPI number — VERDI ONCOLOGY TENNESSEE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERDI ONCOLOGY TENNESSEE, PC
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:
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:
1336779974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 FRANKLIN RD FL 3
Provider Second Line Business Mailing Address:
ATTN. PHYSICIAN BUSINESS SOLUTIONS
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-309-2636
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2004 HAYES ST STE 720
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-284-2310
Provider Business Practice Location Address Fax Number:
615-284-2385
Provider Enumeration Date:
01/23/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUCK
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE
Authorized Official Telephone Number:
407-259-8994

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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