1609820190 NPI number — DR. DAVID MICHAEL ORWIG O D

Table of content: DR. DAVID MICHAEL ORWIG O D (NPI 1609820190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609820190 NPI number — DR. DAVID MICHAEL ORWIG O D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORWIG
Provider First Name:
DAVID
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O D
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:
1609820190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 509
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMBOLDT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38343-0509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-635-0991
Provider Business Mailing Address Fax Number:
731-635-7372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2439 N CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38343-1753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-784-1186
Provider Business Practice Location Address Fax Number:
731-784-0601
Provider Enumeration Date:
05/20/2006

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: 152W00000X , with the licence number:  OD1496 , 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: 32098 . This is a "TLC MEMPHIS MANAGED CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 9491076 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10023282 . This is a "VESTICA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3946215 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4105805 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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