Zachary C. Booms, D.O.
Individual provider Active NPI Emergency Medicine Physician · Fort Campbell, KY
NPI 1851664320 · NPPES record last updated May 28, 2025
Key facts
- NPI
- 1851664320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 3614 (TN)
- Practice address
- 650 Joel Dr
Fort Campbell, KY 42223-5318 - Phone
- (270) 798-3263
- NPI assigned
- Feb 14, 2012
- 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 |
|---|---|---|---|---|
| I20190819003802 | TN | Practitioner - Emergency Medicine | 2365754926 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T1651 | TX | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Emergency Physicians LLC | Emergency Medicine | Current |
Accepting new patients |
Locations
1431 Centerpoint Blvd
Ste 100
Knoxville, TN 37932
Phone (865) 539-8000
9352 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-1000
1818 Albion St
Nashville, TN 37208
Phone (615) 341-4000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 0102203522 | VA | |
| Emergency Medicine Physician | 207P00000X | T1651 | TX | |
| Emergency Medicine Physician | 207P00000X | 3614 | TN | Yes |
Addresses
Primary practice location
650 Joel Dr
Fort Campbell, KY 42223-5318
Mailing address
650 Joel Dr
Fort Campbell, KY 42223-5318
Phone (270) 798-8400
Other practice location 1
3551 Roger Brooke Dr
McHe/Me
Fort Sam Houston, TX 78234-4504
Phone (210) 916-5545
Other providers in Fort Campbell, KY
- Ethan Randall Blomberg
- Natalie Nicole Bobay
- Andrew J Bodwell
- John Ryan Boesch
- Lena Bond
- Teresa Faye Boudrie
- Amanda Adcock Bowen
- Sandra Bowers
- David Allen Boyer
- Polly Erin Boyer
All providers in Fort Campbell, KY · Emergency Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2025. 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.