1346569589 NPI number — MR. ERNEST J WRIGHT III MD

Table of content: MARK EDWARD BOULDEN JR. ATC (NPI 1053764977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346569589 NPI number — MR. ERNEST J WRIGHT III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
ERNEST
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
MD
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:
1346569589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 W THOMAS RD
Provider Second Line Business Mailing Address:
ATTN: ACADEMIC AFFAIRS
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85013-4409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-406-3538
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2011 MURPHY AVE STE 3011
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-327-9543
Provider Business Practice Location Address Fax Number:
615-341-7583
Provider Enumeration Date:
05/27/2010

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: 207T00000X , with the licence number:  56882 , 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: Q037458 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: INPROCESS . This is a "TN MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com