AARON M MOREDOCK PAC, NPI 1063416436 — NASHVILLE (TN)

NPI 1063416436

14+ Years Experience Individual

AARON M MOREDOCK PAC

06/13/2005
PROVIDER ENUMERATION DATE
03/24/2008
LAST UPDATE DATE
1063416436
NPI NUMBER

About AARON M MOREDOCK

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

AARON M MOREDOCK is a provider established in NASHVILLE, TN. The NPI number of AARON M MOREDOCK is 1063416436 and was assigned on 06/13/2005. The practitioners primary taxonomy code is: 363A00000X with license number: 855 TN .

Mailing address

  • City: NASHVILLE
  • State: TN
  • Postal code: 37228
  • Phone: 6153294020
  • Fax: 6153299479
  • Address: ONE VANTAGE WAY
  • Address 2: SUITE B 240

Primary Practice Address

  • Region : NASHVILLE, TN
  • NPI : 1063416436
  • Phone : 6152848484
  • Fax : 6152843854
  • Postalcode : 37236
  • Address : 2000 CHURCH STREET EMERGENCY DEPT

Additional identifiers

  • Identifier: MM1252989
  • Code / Type : 1 - other
  • Identifier state : TN
  • Identifier issuer: DEA NUMBER

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Physician Assistant

  • Taxonomy code: 363A00000X
  • License number: 855
  • License state: TN

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Contacts:

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  • AARON M MOREDOCK PAC
  • Address : 2000 CHURCH STREET EMERGENCY DEPT
  • Region : NASHVILLE, TN
  • NPI : 1063416436
  • Phone : 6152848484
  • Fax : 6152843854
  • Postalcode : 37236

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address2000 CHURCH STREET
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.
Provider Second Line Business Practice Location AddressEMERGENCY DEPT
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.
Provider Business Practice Location Address City NameNASHVILLE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameTN
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code37236
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number6152848484
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number6152843854
The fax number associated with the location address of the provider being identified.
NPI1063416436
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1363A00000X
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Provider Enumeration Date06/13/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated03/24/2008
The date that a record was last updated or changed.
Entity TypeIndividual
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).
Provider Organization Name (Legal Business Name)AARON M MOREDOCK
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing AddressONE VANTAGE WAY
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSUITE B 240
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameNASHVILLE
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameTN
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code37228
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number6153294020
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number6153299479
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1363A00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Physician Assistant
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Provider License Number 1855
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1TN
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1MM1252989
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1TN
Other Provider Identifier State #1
Other Provider Identifier Issuer 1DEA NUMBER
Other Provider Identifier Issuer #1
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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