1780629915 NPI number — MR. ALEJANDRO ALBERTO RIVAS MD

Table of content: MR. ALEJANDRO ALBERTO RIVAS MD (NPI 1780629915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780629915 NPI number — MR. ALEJANDRO ALBERTO RIVAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVAS
Provider First Name:
ALEJANDRO
Provider Middle Name:
ALBERTO
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:
1780629915
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3215 LAKESHORE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLD HICKORY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-889-4212
Provider Business Mailing Address Fax Number:
615-889-3906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3443 DICKERSON PIKE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-889-4212
Provider Business Practice Location Address Fax Number:
615-889-3906
Provider Enumeration Date:
06/19/2006

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: 173000000X , with the licence number:  MD10953 , 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: 3168734 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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