Adult & Pediatric Dermatology Of Tullahoma Pc

LBN: Adult & Pediatric Dermatology Of Tullahoma Pc
Adult & Pediatric Dermatology Of Tullahoma Pc is an health care organization with primary practice located at 100 William Northern Blvd Ste C, Tullahoma TN 37388. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, Allopathic & Osteopathic Physicians / Dermatopathology. Allopathic & Osteopathic Physicians / Dermatology is the primary health care specialty. Adult & Pediatric Dermatology Of Tullahoma Pc can be contacted via phone (931) 455-7400, or through Takegami, Ken T via phone (931) 455-7400.

Contact Information

Primary practice address
100 William Northern Blvd Ste C Tullahoma TN 37388
Phone: (931) 455-7400
Fax: (931) 455-6344
Website:
Map and Directions
Authorized official contact:
Name: Takegami, Ken T Doctor of Medicine (MD)
Phone: (931) 455-7400

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X MD0000021099 Tennessee
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X MD0000021099 Tennessee
Allopathic & Osteopathic Physicians / Dermatopathology 207ND0900X MD0000021099 Tennessee

Profile Details

NPI number 1881658243
LBN Legal business name Adult & Pediatric Dermatology Of Tullahoma Pc
DBA Doing business as
Authorized official Takegami, Ken T Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 13th, 2006
Last updated Dec 3rd, 2009 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1881658243 NPPES
Tennessee MEDICAID 3373903

Popular Providers