1114952330 NPI number — MARTIN D SIMMS MD

Table of content: MARTIN D SIMMS MD (NPI 1114952330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114952330 NPI number — MARTIN D SIMMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMS
Provider First Name:
MARTIN
Provider Middle Name:
D
Provider Name Prefix Text:
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:
1114952330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 25TH AVE N STE 1204
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:
37203-1620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-312-0600
Provider Business Mailing Address Fax Number:
615-320-3259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 25TH AVE N STE 1204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-312-0600
Provider Business Practice Location Address Fax Number:
615-320-3259
Provider Enumeration Date:
07/12/2006

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: 2085R0202X , with the licence number:  27873 , 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: 009804510 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300064457 . This is a "RR MCARE-CI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 300064460 . This is a "RR MCARE-ADR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3048172 . This is a "PLAZA BC/BS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000741749 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3045641 . This is a "ADR BC/BS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: Q003738 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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