PROVIDENCE OBSTETRICS AND GYNECOLOGY, PLLC - NPI NUMBER 1467716142

Summary

Provider Name: PROVIDENCE OBSTETRICS AND GYNECOLOGY, PLLC

NPI Number: 1467716142

Clasification: Obstetrics & Gynecology (207V00000X)

Address:
300 STONECREST BLVD
SUITE 250
SMYRNA, TN
ZIP 37167

Phone Number: (615) 984-4751



Detailed Information

PROVIDENCE OBSTETRICS AND GYNECOLOGY, PLLC is an OB/GYN physician in Smyrna, TN. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. The assigned NPI number for this provider is 1467716142 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

300 STONECREST BLVD
SUITE 250
SMYRNA, TN
ZIP 37167-688
Phone: (615) 984-4751
Fax: (615) 984-4752

The provider's authorized official is Nina D Shapiro .
The authorized official title is Practice Manager and has the following contact phone number (615) 984-4751.

The enumeration date for this NPI number is 6/27/2012 and was last updated on 10/8/2013.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207V00000X Obstetrics & Gynecology 41688 TN Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 103G709136 MEDICARE PIN TN

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1467716142 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name PROVIDENCE OBSTETRICS AND GYNECOLOGY, PLLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 300 STONECREST BLVD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address SUITE 250 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name SMYRNA The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name TN The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 371675688 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 6159844751 The telephone number associated with the location address of the provider being identified.
12 Provider Business Practice Location Address Fax Number 6159844752 The fax number associated with the location address of the provider being identified.
13 Provider Enumeration Date 6/27/2012 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 10/8/2013 The date that a record was last updated or changed.
15 Authorized Official Last Name SHAPIRO The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official First Name NINA The first name of the authorized official.
17 Authorized Official Middle Name D The middle name of the authorized official.
18 Authorized Official Title or Position PRACTICE MANAGER The title or position of the authorized official.
19 Authorized Official Telephone Number 6159844751 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 207V00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Provider License Number 1 41688 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
22 Provider License Number State Code 1 TN The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Other Provider Identifier 1 103G709136 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier Type Code 1 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier State 1 TN
27 Is Organization Subpart N
28 Authorized Official Name Prefix Text DR.
29 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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