Thomas P. Bovine, M.D.
Individual provider Active NPI Family Medicine Physician · Dayton, TN
NPI 1104982453 · NPPES record last updated Jan 3, 2014
Key facts
- NPI
- 1104982453
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD14692 (TN)
- Practice address
- 7794 Rhea County Hwy
Suite 101
Dayton, TN 37321-5981 - Phone
- (423) 775-3363
- Fax
- (423) 775-3366
- NPI assigned
- Dec 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090110000114 | TN | Practitioner - Family Practice | 4880757236 |
Receives reassigned benefits from 1 practitioner Practice locations: Dayton, TN |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD14692 | TN | MD | Family Medicine Physician |
| 14692 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD14692 | TN | Yes |
Addresses
Primary practice location
7794 Rhea County Hwy
Suite 101
Dayton, TN 37321-5981
Mailing address
7794 Rhea County Hwy
Suite 101
Dayton, TN 37321-5981
Phone (423) 775-3363
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3199194 | Medicaid | TN |
Other providers in Dayton, TN
- Michael John Birdwell
- Gary Chase Black
- Faith Blackmon
- Erica Blair
- Shayla Lynne Bogga
- Stacy Gose Bowers
- William R. Boyd Jr.
- Daniel S Brashear
- Bravo Webb PLLC
- Michelle Linn Brenner
All providers in Dayton, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.