Provider Demographics
NPI:1104187624
Name:DONALD J. BOATRIGHT MD., PC
Entity Type:Organization
Organization Name:DONALD J. BOATRIGHT MD., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOATRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-865-8269
Mailing Address - Street 1:205 5TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-2435
Mailing Address - Country:US
Mailing Address - Phone:615-384-7580
Mailing Address - Fax:615-384-0516
Practice Address - Street 1:205 5TH AVE E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2435
Practice Address - Country:US
Practice Address - Phone:615-384-7580
Practice Address - Fax:615-384-0516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONALD J. BOATRIGHT MD., PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16522207R00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4057158OtherBCBS
TN4057158Medicaid
TN7574554OtherAETNA
TN2566732OtherCIGNA
TN4114694Medicaid
TN4057165Medicaid
TN4058614Medicaid
TN4114694Medicaid
TN4057165Medicaid
TN4058614Medicaid