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

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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
1 NPI 1467716142
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name PROVIDENCE OBSTETRICS AND GYNECOLOGY, PLLC
5 Provider First Line Business Practice Location Address 300 STONECREST BLVD
6 Provider Second Line Business Practice Location Address SUITE 250
7 Provider Business Practice Location Address City Name SMYRNA
8 Provider Business Practice Location Address State Name TN
9 Provider Business Practice Location Address Postal Code 371675688
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 6159844751
12 Provider Business Practice Location Address Fax Number 6159844752
13 Provider Enumeration Date 6/27/2012
14 Last Update Date 10/8/2013
15 Authorized Official Last Name SHAPIRO
16 Authorized Official First Name NINA
17 Authorized Official Middle Name D
18 Authorized Official Title or Position PRACTICE MANAGER
19 Authorized Official Telephone Number 6159844751
20 Healthcare Provider Taxonomy Code 1 207V00000X
21 Provider License Number 1 41688
22 Provider License Number State Code 1 TN
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Other Provider Identifier 1 103G709136
25 Other Provider Identifier Type Code 1 08
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: 9/11/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.