1962493676 NPI number — DR. NABIL BOUTROS MD

Table of content: DR. NABIL BOUTROS MD (NPI 1962493676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962493676 NPI number — DR. NABIL BOUTROS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOUTROS
Provider First Name:
NABIL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1962493676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE VANTAGE WAY
Provider Second Line Business Mailing Address:
SUITE B-240 MIDDLE TENNESSEE EMERGENCY PHYSICIANS, PC
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
27228-1562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-329-4020
Provider Business Mailing Address Fax Number:
615-329-9479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 N. HIGHLAND AVE
Provider Second Line Business Practice Location Address:
MIDDLE TENNESSEE MEDICAL CENTER
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-251-2014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2005

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: 207P00000X , with the licence number:  32688 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 41834 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 453051001 . This is a "GROUP HEALTH GRP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 860373636 . This is a "HUMANA GROUP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 892150 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0728670 . This is a "BLUE CROSS BLUE SHIELD GR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 3981220 . This is a "EVERCARE GRP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AW1436 . This is a "HEALTHNET GRP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com