Provider Demographics
NPI:1215330592
Name:THOMAS P. BOVINE MD
Entity type:Organization
Organization Name:THOMAS P. BOVINE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-775-3363
Mailing Address - Street 1:7794 RHEA COUNTY HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-5981
Mailing Address - Country:US
Mailing Address - Phone:423-775-3363
Mailing Address - Fax:423-775-3366
Practice Address - Street 1:7794 RHEA COUNTY HWY STE 101
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5981
Practice Address - Country:US
Practice Address - Phone:423-775-3363
Practice Address - Fax:423-775-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14692207Q00000X
TN13493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3199194Medicare PIN