Provider Demographics
NPI:1629246996
Name:RICHARD A BAGBY JR MD PC
Entity Type:Organization
Organization Name:RICHARD A BAGBY JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAGBY
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:931-580-2437
Mailing Address - Street 1:183 HOSPITAL RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2471
Mailing Address - Country:US
Mailing Address - Phone:931-580-2437
Mailing Address - Fax:931-967-8119
Practice Address - Street 1:183 HOSPITAL RD
Practice Address - Street 2:SUITE G
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2471
Practice Address - Country:US
Practice Address - Phone:931-580-2437
Practice Address - Fax:931-967-8119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD011925207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2009891OtherBLUE CROSS TN
TN2009891OtherBLUE CROSS TN
TND32053Medicare UPIN