Provider Demographics
NPI: | 1619945292 |
---|---|
Name: | HILL, KEITH REGEN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | KEITH |
Middle Name: | REGEN |
Last Name: | HILL |
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: | 8 NEW MIDDLETON HWY |
Mailing Address - Street 2: | SUITE A |
Mailing Address - City: | GORDONSVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 38563-6603 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-683-3400 |
Mailing Address - Fax: | 615-683-3402 |
Practice Address - Street 1: | 8 NEW MIDDLETON HWY |
Practice Address - Street 2: | SUITE A |
Practice Address - City: | GORDONSVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 38563-6603 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-683-3400 |
Practice Address - Fax: | 615-683-3402 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-09 |
Last Update Date: | 2015-03-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 37791 | 207Q00000X |
TN | MD0000037791 | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 4277588 | Other | BCBST |
TN | 4277588 | Other | BCBST |
TN | 3887750 | Medicare PIN |