1790879310 NPI number — MR. MICHAEL F CONAR P.AP-C

Table of content: MR. MICHAEL F CONAR P.AP-C (NPI 1790879310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790879310 NPI number — MR. MICHAEL F CONAR P.AP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONAR
Provider First Name:
MICHAEL
Provider Middle Name:
F
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.AP-C
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:
1790879310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2535 GEORGETOWN RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37311-3534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-244-0311
Provider Business Mailing Address Fax Number:
615-216-8538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2535 GEORGETOWN RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37311-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-244-0311
Provider Business Practice Location Address Fax Number:
615-216-8538
Provider Enumeration Date:
10/03/2006

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: 363AM0700X , with the licence number:  PA812 , 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: 2000307 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 621038898 . This is a "TAX ID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0103 . This is a "JOHN DEERE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 970027904 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: FP62706 . This is a "WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0140208 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3669187 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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