NPIMap

Organization Active NPI

Uap Lebanon Endo, LLC

  • Certified Registered Nurse Anesthetist
  • Lebanon, TN
National Provider Identifier
1134471725
Registry record updated May 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
UAP LEBANON ENDO, LLC
Practice address
100 Physicians Way
Ste 340
Lebanon, TN 37090-8102
Phone
(615) 466-9532
NPI assigned
Oct 8, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2015

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

Authorized official

Name
Kimberly M Harper
Title
Officer/Authorized Official
Phone
(972) 713-3547

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

100 Physicians Way
Ste 340
Lebanon, TN 37090-8102

Mailing address

15305 Dallas Pkwy
#1600
Addison, TX 75001-4637
Phone (972) 713-3547

Other identifiers 2

IdentifierTypeStateIssuer
6023768OtherTNBCBS OF TENNESSE, INC.
Q008286MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150203001030 TN Part B Supplier - Clinic/Group Practice 0143545715 Receives reassigned benefits from 7 practitioners
Practice locations: Lebanon, TN

National Provider Directory

National Provider Directory

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

Locations

100 Physicians Way
Ste 340
Lebanon, TN 37090
Phone (615) 449-3335

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430956800000",
    "number": "1134471725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15305 DALLAS PKWY",
            "address_2": "#1600",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750014637",
            "telephone_number": "972-713-3547",
            "fax_number": "972-534-1568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PHYSICIANS WAY",
            "address_2": "STE 340",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370908102",
            "telephone_number": "615-466-9532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UAP LEBANON ENDO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-08",
        "last_updated": "2015-05-07",
        "status": "A",
        "authorized_official_last_name": "HARPER",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "972-713-3547"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNESSE, INC.",
            "identifier": "6023768",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q008286",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.