Basic Information
Provider Information | |||||||||
NPI: | 1265599518 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TROMBLEY | ||||||||
FirstName: | JOSEPH | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 115 WINWOOD DR | ||||||||
Address2: | SUITE 105 | ||||||||
City: | LEBANON | ||||||||
State: | TN | ||||||||
PostalCode: | 370871340 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6154444126 | ||||||||
FaxNumber: | 8557852890 | ||||||||
Practice Location | |||||||||
Address1: | 115 WINWOOD DR | ||||||||
Address2: | SUITE 105 | ||||||||
City: | LEBANON | ||||||||
State: | TN | ||||||||
PostalCode: | 370871340 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6154444126 | ||||||||
FaxNumber: | 8557852890 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/03/2007 | ||||||||
LastUpdateDate: | 02/13/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA0000000627 | TN | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | 4326617 | 01 | TN | BCBS OF TN | OTHER | 1508801 | 05 | TN |   | MEDICAID | 620842749 | 01 | TN | HUMANA | OTHER | 3284468 | 01 | TN | UNITED HEALTHCARE | OTHER | P01275147 | 01 | TN | R/R MEDICARE | OTHER |