1396763645 NPI number — RAFID J HUSSEIN DO

Table of content: RAFID J HUSSEIN DO (NPI 1396763645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396763645 NPI number — RAFID J HUSSEIN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUSSEIN
Provider First Name:
RAFID
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1396763645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 STEAM PLANT RD STE 450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLATIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37066-3079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-822-6716
Provider Business Mailing Address Fax Number:
615-328-3709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 STEAM PLANT RD STE 450
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALLATIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37066-3079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-822-6716
Provider Business Practice Location Address Fax Number:
615-328-3709
Provider Enumeration Date:
07/17/2006

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: 207RG0100X , with the licence number:  1009014097 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036100635 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1396763645 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".