Provider Demographics
NPI:1487851044
Name:BELLEVUE MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:BELLEVUE MEDICAL GROUP, LLC
Other - Org Name:WEST END MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-284-6861
Mailing Address - Street 1:PO BOX 504556
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:615-297-6006
Mailing Address - Fax:615-298-6778
Practice Address - Street 1:4230 HARDING RD
Practice Address - Street 2:SUITE 530 HEART INSTITUTE
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-297-6006
Practice Address - Fax:615-298-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3374489Medicaid
TN4028930OtherBLUE CROSS BLUE SHIELD
TNDG9953OtherRAILROAD MEDICARE
TN3374489Medicaid