1457329385 NPI number — DAVID REUEL NAVORSKA DO

Table of content: DAVID REUEL NAVORSKA DO (NPI 1457329385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457329385 NPI number — DAVID REUEL NAVORSKA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAVORSKA
Provider First Name:
DAVID
Provider Middle Name:
REUEL
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:
1457329385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 TOWN CREEK RD E
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
LENOIR CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37772-6289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-647-3360
Provider Business Mailing Address Fax Number:
865-647-3369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AAFMH
Provider Second Line Business Practice Location Address:
650 JOEL DRIVE
Provider Business Practice Location Address City Name:
FORT CAMPBELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42223-3563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-956-0077
Provider Business Practice Location Address Fax Number:
865-647-3369
Provider Enumeration Date:
03/08/2006

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:  DO1166 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 1166 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5082544 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00233206 . This is a "MEDICARE - RAILROAD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3766580 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100010271 . This is a "PHP TNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4108906 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 602004441 . This is a "CARITEN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3304732 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3704598 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: TN0145 . This is a "UHC/JD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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