1730132788 NPI number — SHIVA SHANKAR NATARAJAN

Table of content: SHIVA SHANKAR NATARAJAN (NPI 1730132788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730132788 NPI number — SHIVA SHANKAR NATARAJAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NATARAJAN
Provider First Name:
SHIVA
Provider Middle Name:
SHANKAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1730132788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7645 WOLF RIVER CIR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38138-1751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-405-0275
Provider Business Mailing Address Fax Number:
901-922-6840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7645 WOLF RIVER CIR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38138-1751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-405-0275
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

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: 2084N0400X , with the licence number:  031974 , 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: 152654001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16568 . This is a "TLC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620903564 . This is a "VESTICA/OMNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 98965 . This is a "BCBS OF ARKANSAS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 2075825 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 339702002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3857230 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4170697 . This is a "BC BS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7701233 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00123843 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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