1518978709 NPI number — DR. WILLIAM HOWARD IRWIN III PHD

Table of content: DR. WILLIAM HOWARD IRWIN III PHD (NPI 1518978709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518978709 NPI number — DR. WILLIAM HOWARD IRWIN III PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IRWIN
Provider First Name:
WILLIAM
Provider Middle Name:
HOWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
PHD
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:
1518978709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 LEBANON RD
Provider Second Line Business Mailing Address:
ALVIN C. YORK VAMC, ASPS 126
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37129-1237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-225-2848
Provider Business Mailing Address Fax Number:
615-225-6351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 LEBANON RD
Provider Second Line Business Practice Location Address:
ALVIN C. YORK VAMC, ASPS 126
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37129-1237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-225-2848
Provider Business Practice Location Address Fax Number:
615-225-6351
Provider Enumeration Date:
08/11/2006

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: 235Z00000X , with the licence number:  5968 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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