William D Lyles Jr., MD
Individual provider Active NPI Family Medicine Physician · Hartsville, TN
NPI 1801001912 · NPPES record last updated Mar 18, 2014
Key facts
- NPI
- 1801001912
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 16864 (TN)
- Practice address
- 205 Broadway
Hartsville, TN 37074-1303 - Phone
- (615) 374-0703
- Fax
- (615) 374-0019
- NPI assigned
- May 11, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031224000003 | TN | Practitioner - Family Practice |
1850299009 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16864 | TN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Concord Medical Group PLLC | Current |
Accepting new patients | |
| Trousdale Medical Clinic | Family Medicine | Current |
Accepting new patients |
| Concord Medical Group of Texas PLLC | Current |
Accepting new patients | |
| Emcare Physician Providers, Inc. | Past | Accepting new patients | |
| William D. Lyles, Jr., M.D. and Associates, PLLC | Family Medicine | Past |
Accepting new patients |
| Emergency Physicians at Trousdale PLLC | Past | Accepting new patients | |
| Sycamore Emergency Physicians LLC | Past | Accepting new patients | |
| Medical Necessities, Inc | Past | Accepting new patients | |
| Emergency Coverage, LLC | Family Medicine | Past | Accepting new patients |
| Hopewell Medical | Past | Accepting new patients |
Locations
5001 E Main St
Erin, TN 37061
Phone (336) 944-6420
205 Broadway
Hartsville, TN 37074
Phone (615) 374-0317
205A Broadway
Hartsville, TN 37074
Phone (615) 374-0703
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 16864 | TN | Yes |
| Obstetrics & Gynecology Physician | 207V00000X | 16864 | TN |
Addresses
Primary practice location
205 Broadway
Hartsville, TN 37074-1303
Mailing address
205 Broadway
P.O. Box 486
Hartsville, TN 37074-1303
Phone (615) 374-0703
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3860457 | Medicaid | TN |
Other providers in Hartsville, TN
- Aubrey A. Lamptey
- Kyla Lou Langford
- Kelli Michelle Ledbetter
- Livingston Family Practice, PLLC
- Amanda S Livingston
- Andrew Herod Marshall
- Samuel C. Moore
- Stacy Amanda Morris
- Matthew Wayne Moses
- Nursing Centers Unlimited Inc
All providers in Hartsville, 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 Mar 18, 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.