Provider Demographics
NPI:1275520827
Name:RENTUZA, RONALD C (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:C
Last Name:RENTUZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:615-284-2222
Mailing Address - Fax:
Practice Address - Street 1:5653 FRIST BLVD
Practice Address - Street 2:SUITE 630
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2094
Practice Address - Country:US
Practice Address - Phone:615-391-3971
Practice Address - Fax:615-232-3899
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38945207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100261950Medicaid
TN3895825Medicaid
TNI08891Medicare UPIN
TN3895825Medicaid
TN4120043OtherTENNCARE
TN9944147OtherCIGNA
TN3895825Medicaid
TN3895826Medicare PIN
TN7746682OtherAETNA
TNP00312097OtherR/R MCR