1851975296 NPI number — TANNER NEEL WOMBLE MD. MBA

Table of content: TANNER NEEL WOMBLE MD. MBA (NPI 1851975296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851975296 NPI number — TANNER NEEL WOMBLE MD. MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOMBLE
Provider First Name:
TANNER
Provider Middle Name:
NEEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD. MBA
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:
1851975296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 S LIMESTONE ALBERT B CHANDLER HOSPITAL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40536-2286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-323-2131
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 S LIMESTONE ALBERT B CHANDLER HOSPITAL PAVILION A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40536-2286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-2131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2021

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: 390200000X , with the licence number:  IP1776 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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