1114948122 NPI number — NEIL HOWARD SPITALNY M.D.

Table of content: NEIL HOWARD SPITALNY M.D. (NPI 1114948122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114948122 NPI number — NEIL HOWARD SPITALNY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPITALNY
Provider First Name:
NEIL
Provider Middle Name:
HOWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1114948122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5022 OLD GODSEY LN
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
HIXSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37343-6600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-870-4999
Provider Business Mailing Address Fax Number:
423-870-1985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5022 OLD GODSEY LN
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
HIXSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37343-6600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-870-4999
Provider Business Practice Location Address Fax Number:
423-870-1985
Provider Enumeration Date:
07/22/2006

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: 207X00000X , with the licence number:  MD15735 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 051388 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00949451A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1537414 . This is a "UMWA HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4139453 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100020710 . This is a "HEALTH STRATEGIES" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3012938 . This is a "ACCESS MED PLUS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 621753676 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0101 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1502623 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 621753676 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3103052 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 373943600 . This is a "OWCP KENTUCKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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