Provider Demographics
NPI:1578766739
Name:JOHN W. BACON M.D. PLLC
Entity Type:Organization
Organization Name:JOHN W. BACON M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-452-7223
Mailing Address - Street 1:300 STEAM PLANT RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3032
Mailing Address - Country:US
Mailing Address - Phone:615-452-7223
Mailing Address - Fax:615-452-3894
Practice Address - Street 1:300 STEAM PLANT RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3032
Practice Address - Country:US
Practice Address - Phone:615-452-7223
Practice Address - Fax:615-452-3894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000035633207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376661Medicaid
TN3870259Medicare ID - Type Unspecified
TN3376661Medicaid