Provider Demographics
NPI:1518907609
Name:BYSTRITSKI, ALBERT V (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:V
Last Name:BYSTRITSKI
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:PO BOX 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2404
Practice Address - Country:US
Practice Address - Phone:931-967-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37369207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3886530Medicaid
TN3886531Medicaid
TN4063780OtherBLUE CROSS
TN4149683OtherBLUE CROSS
TNP00305958OtherMEDICARE RAILROAD
TN4149683OtherBLUE CROSS
TN3886530Medicaid
TN3886530Medicare PIN