TOP FLIGHT MEDICAL GROUP - NPI NUMBER 1750717872

Summary

Provider Name: TOP FLIGHT MEDICAL GROUP

NPI Number: 1750717872

Clasification: Specialist (174400000X)

Address:
326 ASBURY AVE STE 102
PHYSICIANS OFFICE BUILDING
RIPLEY, TN
ZIP 38063

Phone Number: (615) 340-3436



Detailed Information

TOP FLIGHT MEDICAL GROUP is a specialist in Ripley, TN. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. The assigned NPI number for this provider is 1750717872 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

326 ASBURY AVE STE 102
PHYSICIANS OFFICE BUILDING
RIPLEY, TN
ZIP 38063-577
Phone: (615) 340-3436
Fax: (877) 472-3945

The provider's authorized official is Sekou Molette .
The authorized official title is Physician and has the following contact phone number (615) 340-3436.

The enumeration date for this NPI number is 9/20/2013 and was last updated on 9/20/2013.

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 174400000X Specialist 31865 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 H00315 MEDICARE UPIN TN

NPI Record

No. Field Name Field Value
1 NPI 1750717872
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name TOP FLIGHT MEDICAL GROUP
5 Provider First Line Business Practice Location Address 326 ASBURY AVE STE 102
6 Provider Second Line Business Practice Location Address PHYSICIANS OFFICE BUILDING
7 Provider Business Practice Location Address City Name RIPLEY
8 Provider Business Practice Location Address State Name TN
9 Provider Business Practice Location Address Postal Code 380635577
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 6153403436
12 Provider Business Practice Location Address Fax Number 8774723945
13 Provider Enumeration Date 9/20/2013
14 Last Update Date 9/20/2013
15 Authorized Official Last Name MOLETTE
16 Authorized Official First Name SEKOU
17 Authorized Official Title or Position PHYSICIAN
18 Authorized Official Telephone Number 6153403436
19 Healthcare Provider Taxonomy Code 1 174400000X
20 Provider License Number 1 31865
21 Provider License Number State Code 1 TN
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 H00315
24 Other Provider Identifier Type Code 1 02
25 Other Provider Identifier State 1 TN
26 Is Organization Subpart N
27 Authorized Official Credential Text MD
28 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 10/12/2014
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