Phillip D Tidwell

Primary specialty

Pulmonary Diagnostics Registered Respiratory TherapistTaxonomy code 2279P1004X

License

RRT0000000395 Issued in TN

Practice address

2148 Aztec Dr
Dyersburg, TN 38024-1841

Phone

(731) 589-6156

Fax

(615) 467-8971

NPI assigned

Oct 1, 2010

Last updated

Jun 12, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23284/brand/2/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Proactive MD, LLC

  • Pulmonary Diagnostics Registered Respiratory Therapist
  • Dyersburg, TN
  • NPI 1326346412
  NPD (past) Authorized official

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

{
    "created_epoch": "1285891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370995200000",
    "number": "1659680114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2148 AZTEC DR",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380241841",
            "telephone_number": "731-589-6156",
            "fax_number": "615-467-8971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2148 AZTEC DR",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380241841",
            "telephone_number": "731-589-6156",
            "fax_number": "615-467-8971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "PHILLIP",
        "middle_name": "D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-01",
        "last_updated": "2013-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2279P1004X",
            "taxonomy_group": "",
            "desc": "Respiratory Therapist, Registered, Pulmonary Diagnostics",
            "state": "TN",
            "license": "RRT0000000395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Clinic, PLLC
• The West Clinic P.C.
• Atonya Thomas, RN
• Laura Thomas, PT
• Thomas Reece Thompson, MD
• Shari P Tidwell, F.NP.
• Felisha A Tillman, LPC
• TN Dyer Op LLC
• Valerie Tomlin, FNP
• William Matthew Tosh, D.O.

• Registered Respiratory Therapist in Dyersburg, TN
• Providers in Dyersburg, TN by specialty
• Registered Respiratory Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; 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.