1922053750 NPI number — TENNESSEE INPATIENT MEDICINE ASSOCIATES, PLLC

Table of content: (NPI 1922053750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922053750 NPI number — TENNESSEE INPATIENT MEDICINE ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENNESSEE INPATIENT MEDICINE ASSOCIATES, 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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1922053750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30355-0007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-397-0060
Provider Business Mailing Address Fax Number:
678-397-0065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 W 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38501-1760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-646-2770
Provider Business Practice Location Address Fax Number:
631-525-1176
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
678-397-0060

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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