Provider Demographics
NPI:1346419751
Name:WILLIAM VAN BINGHAM, M.D., P.C.
Entity Type:Organization
Organization Name:WILLIAM VAN BINGHAM, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-683-0642
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 803
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-683-0642
Mailing Address - Fax:901-881-6011
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 803
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-683-0642
Practice Address - Fax:901-881-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34970208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4037497001OtherCIGNA
3862008OtherMEDICARE INDIVIDUAL
7703236OtherAETNA
1940206OtherUNITED HEALTHCARE
TN4083525OtherBLUE CROSS BLUE SHIELD
3862008OtherMEDICARE INDIVIDUAL
TN4083525OtherBLUE CROSS BLUE SHIELD
=========OtherHUMANA
=========OtherWINDSOR
1940206OtherUNITED HEALTHCARE