1841301256 NPI number — DR. TAMMY KATHRYN GEPHART DPM

Table of content: (NPI 1326357831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841301256 NPI number — DR. TAMMY KATHRYN GEPHART DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEPHART
Provider First Name:
TAMMY
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

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:
1841301256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11401 SNOW LEOPARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89138-6211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-819-1770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6850 N DURANGO DR STE 216
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89149-4597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-851-7287
Provider Business Practice Location Address Fax Number:
702-224-5653
Provider Enumeration Date:
08/31/2006

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: 213ES0103X , with the licence number:  2062 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: POD001122 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 202I483324 . This is a "MEDICARE OF GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 273104170 . This is a "HUMANA GROUP HEALTH PLANS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 6489180001 . This is a "RAILROAD MEDICARE (AUGUSTA, GA)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 273104170 . This is a "COVENTRY HEALTH OF GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1841301256 . This is a "BLUE CROSS BLUE SHIELD OF GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 273104170 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1811291149 . This is a "DMERC" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 273104170 . This is a "AETNA HEALTH PLANS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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