1578766739 NPI number — JOHN W. BACON M.D. PLLC

Table of content: (NPI 1578766739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578766739 NPI number — JOHN W. BACON M.D. PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN W. BACON M.D. PLLC
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:
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:
1578766739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 STEAM PLANT RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
GALLATIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37066-3032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-452-7223
Provider Business Mailing Address Fax Number:
615-452-3894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 STEAM PLANT RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
GALLATIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37066-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-452-7223
Provider Business Practice Location Address Fax Number:
615-452-3894
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BACON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DR OWNER
Authorized Official Telephone Number:
615-452-7223

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  MD0000035633 , 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: 3376661 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com