1356351084 NPI number — DR. POLLY OLINGER BILLIPS M.D.

Table of content: (NPI 1790455509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356351084 NPI number — DR. POLLY OLINGER BILLIPS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BILLIPS
Provider First Name:
POLLY
Provider Middle Name:
OLINGER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1356351084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSPORT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37662-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-857-2093
Provider Business Mailing Address Fax Number:
423-857-2012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 MEDICAL PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 3800
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37620-7346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-990-2466
Provider Business Practice Location Address Fax Number:
423-990-2407
Provider Enumeration Date:
08/08/2006

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: 207Q00000X , with the licence number:  MD0000031213 , 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: 1356351084 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38579151 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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