1225263460 NPI number — PROVENCE AND HALEY, PC

Table of content: (NPI 1225263460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225263460 NPI number — PROVENCE AND HALEY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROVENCE AND HALEY, PC
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:
6
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:
1225263460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4322 HARDING PIKE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-2490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-829-7000
Provider Business Mailing Address Fax Number:
615-829-7001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4322 HARDING PIKE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-2490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-829-7000
Provider Business Practice Location Address Fax Number:
615-829-7001
Provider Enumeration Date:
05/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
MINA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
615-419-1943

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  DS7219 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223S0112X , with the licence number: DS4607 , 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: 1275531972 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7219 . This is a "DENTAL LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1982601829 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 918666 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2006315 . This is a "BCBST" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4607 . This is a "DENTAL LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3141185 . This is a "BCBST" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 667954 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".




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