Basic Information
Provider Information | |||||||||
NPI: | 1326045154 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PALMER | ||||||||
FirstName: | EDMUND | ||||||||
MiddleName: | T | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 294 SUMMAR DR | ||||||||
Address2: | DEPT 289 | ||||||||
City: | JACKSON | ||||||||
State: | TN | ||||||||
PostalCode: | 383013915 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7312658220 | ||||||||
FaxNumber: | 7312658355 | ||||||||
Practice Location | |||||||||
Address1: | 294 SUMMAR DR | ||||||||
Address2: |   | ||||||||
City: | JACKSON | ||||||||
State: | TN | ||||||||
PostalCode: | 383013915 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7314231932 | ||||||||
FaxNumber: | 7314234919 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/07/2005 | ||||||||
LastUpdateDate: | 07/12/2007 | ||||||||
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 | 207R00000X | 9656 | TN | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 129522 | 01 | TN | BETTER HEALTH | OTHER | 2178223 | 01 | TN | CIGNA | OTHER | 9280 | 01 | TN | TLC | OTHER | 3174484 | 05 | TN |   | MEDICAID | 59982 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER |