Provider Demographics
NPI:1053650200
Name:ADULT AND GERIATRIC PSYCHIATRY SERVICE
Entity Type:Organization
Organization Name:ADULT AND GERIATRIC PSYCHIATRY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-283-8801
Mailing Address - Street 1:101 MED TECH PKWY STE 407
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4000
Mailing Address - Country:US
Mailing Address - Phone:423-283-8801
Mailing Address - Fax:423-282-4533
Practice Address - Street 1:1618 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-7700
Practice Address - Country:US
Practice Address - Phone:423-677-6787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD191952084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty