Basic Information
| Provider Information | |||||||||
| NPI: | 1194750463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1725 MEDICAL CENTER PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158934100 | ||||||||
| FaxNumber: | 6158939713 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 MEDICAL CENTER PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158934100 | ||||||||
| FaxNumber: | 6158939713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 12/20/2007 | ||||||||
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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 | 174400000X | MD0000027511 | TN | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 3099582 | 05 | TN | MEDICAID | 4084312 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER |