1861590002 NPI number — DR. JAMES J MACCARONE D.O.

Table of content: DR. JAMES J MACCARONE D.O. (NPI 1861590002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861590002 NPI number — DR. JAMES J MACCARONE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACCARONE
Provider First Name:
JAMES
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1861590002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3540
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37043-3540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-648-0202
Provider Business Mailing Address Fax Number:
931-648-0252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 CHESAPEAKE LN
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37040-5263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-648-0202
Provider Business Practice Location Address Fax Number:
931-648-0252
Provider Enumeration Date:
09/20/2006

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: 207R00000X , with the licence number:  DO1235 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0000X , with the licence number: 00000260 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 110204333 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3305160 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 179292 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3144330 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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