1417952581 NPI number — DR. TOD RAYMOND BUSHMAN DPM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417952581 NPI number — DR. TOD RAYMOND BUSHMAN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSHMAN
Provider First Name:
TOD
Provider Middle Name:
RAYMOND
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1417952581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 42ND AVE N STE 400
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:
37209-3658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-292-5722
Provider Business Mailing Address Fax Number:
615-346-6225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 S MOUNT JULIET RD STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT JULIET
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37122-3923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-874-9667
Provider Business Practice Location Address Fax Number:
615-871-9682
Provider Enumeration Date:
06/16/2005

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: 213EP1101X , with the licence number:  DPM 471 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: DPM 471 , 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: Q019425 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6083425 . This is a "BCBS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3376588 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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