1891783981 NPI number — SUMMIT BONE & JOINT, PLLC

Table of content: (NPI 1891783981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891783981 NPI number — SUMMIT BONE & JOINT, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT BONE & JOINT, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1891783981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 306020
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37230-6020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-232-3838
Provider Business Mailing Address Fax Number:
615-232-3833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5653 FRIST BLVD
Provider Second Line Business Practice Location Address:
SUITE 731
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-232-3838
Provider Business Practice Location Address Fax Number:
615-232-3833
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LADOUCEUR
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
615-232-3838

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MD0000031901 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XX0005X , with the licence number: MD0000031901 , 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: 2638088 . This is a "AETNA HMO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4023754 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1506501 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2000043639 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0940372 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0516031005 . This is a "CIGNA HMO-POS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0516031006 . This is a "CIGNA PPO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5282039 . This is a "AETNA PPO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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