Provider Demographics
NPI:1366496655
Name:BIRDWELL, BEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:J
Last Name:BIRDWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5653 FRIST BLVD
Mailing Address - Street 2:SUITE 630
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2094
Mailing Address - Country:US
Mailing Address - Phone:615-391-3971
Mailing Address - Fax:615-369-2032
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:615-369-2032
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN4334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2004611OtherBCBS
TN4082406OtherAETNA
TNP2842748OtherFIRST HEALTH
TN2004611OtherTENNCARE
TN2573809OtherCIGNA
TN110090707OtherR/R MEDICARE
TN3144947Medicaid
TNB02096OtherHEALTHSPRING
TNB02096OtherHEALTHSPRING
TN3144948Medicare PIN