Basic Information
| Provider Information | |||||||||
| NPI: | 1033159736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHURCH | ||||||||
| FirstName: | DON | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 RIVER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CONSHOHOCKEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194282439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003553818 | ||||||||
| FaxNumber: | 6108342862 | ||||||||
| Practice Location | |||||||||
| Address1: | 3441 DICKERSON PIKE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372072539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157692000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 03/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 39590 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | M8604 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00650240 | 01 | TX | RAILROAD | OTHER | 191299001 | 05 | TX | MEDICAID | 191299002 | 05 | TX | MEDICAID | 8AB543 | 01 | TX | BCBS THRU HEB | OTHER | 8AA315 | 01 | TX | BCBS | OTHER | P00660092 | 01 | TX | RAILROAD MCARE THRU HEB | OTHER | 3331286 | 05 | TN | MEDICAID |