Provider Demographics
NPI:1477553170
Name:VAN WYHE, GALEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:GALEN
Middle Name:G
Last Name:VAN WYHE
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 1:7460 WOLF RIVER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-763-0200
Mailing Address - Fax:901-260-1713
Practice Address - Street 1:7460 WOLF RIVER BOULEVARD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-763-0200
Practice Address - Fax:901-260-1713
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28414207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118117Medicaid
AR129928001Medicaid
TN3804221Medicaid
P00854022OtherRAILROAD MEDICARE
TN4270160OtherBCBS TN
MS00118117Medicaid
TN4270160OtherBCBS TN
TN103I060412Medicare PIN