NPIMap

Organization Active NPI

Tullahoma Internal Medicine, PLLC

  • Internal Medicine Physician
  • Tullahoma, TN
National Provider Identifier
1053430439
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD0000027908 Issued in TN
Legal business name
TULLAHOMA INTERNAL MEDICINE, PLLC
Practice address
1330 Cedar LN
Suite 100
Tullahoma, TN 37388-2283
Phone
(931) 393-3366
Fax
(931) 393-1065
NPI assigned
Mar 28, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rimda Gupta, M.D.NPI 1679566772
Title
Chief Manager, Owner
Phone
(931) 393-3366

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD0000027908 TN Primary

Addresses

Primary practice location

1330 Cedar LN
Suite 100
Tullahoma, TN 37388-2283

Mailing address

PO Box 1896
Tullahoma, TN 37388-1896
Phone (931) 393-3366

Other identifiers 3

IdentifierTypeStateIssuer
3810510MedicaidTN
1679566772OtherTNIND NPI NUMBER
MD27908OtherTNLICENSE NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053430439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1896",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373881896",
            "telephone_number": "931-393-3366",
            "fax_number": "931-393-1065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 CEDAR LN",
            "address_2": "SUITE 100",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882283",
            "telephone_number": "931-393-3366",
            "fax_number": "931-393-1065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TULLAHOMA INTERNAL MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "RIMDA",
        "authorized_official_title_or_position": "CHIEF MANAGER, OWNER",
        "authorized_official_telephone_number": "931-393-3366",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD0000027908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810510",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IND NPI NUMBER",
            "identifier": "1679566772",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "MD27908",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tullahoma, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.