Provider Demographics
NPI:1417299223
Name:TOP FLIGHT MEDICAL GROUP
Entity Type:Organization
Organization Name:TOP FLIGHT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SEKOU
Authorized Official - Middle Name:FM
Authorized Official - Last Name:MOLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-340-3436
Mailing Address - Street 1:PO BOX 330760
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-7505
Mailing Address - Country:US
Mailing Address - Phone:615-340-3436
Mailing Address - Fax:877-472-3945
Practice Address - Street 1:1150 PERIMETER PARK DR
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0927
Practice Address - Country:US
Practice Address - Phone:615-340-3436
Practice Address - Fax:877-472-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH00315Medicare UPIN