1578640660 NPI number — MR. JAMES S LINDER MD

Table of content: MR. JAMES S LINDER MD (NPI 1578640660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578640660 NPI number — MR. JAMES S LINDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDER
Provider First Name:
JAMES
Provider Middle Name:
S
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
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:
1578640660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6258 POPLAR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119-4713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-680-1990
Provider Business Mailing Address Fax Number:
901-680-1944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6258 POPLAR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-680-1990
Provider Business Practice Location Address Fax Number:
901-680-1944
Provider Enumeration Date:
11/01/2006

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: 207W00000X , with the licence number:  34047 , 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: 122126 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4063288 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00069437 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 139924001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3235267 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3850740 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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