Provider Demographics
NPI:1659497394
Name:MOHAMMAD BHIDYA MD PC
Entity Type:Organization
Organization Name:MOHAMMAD BHIDYA MD PC
Other - Org Name:QUALITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT SECRETARY MOHAMMAD BHIDYA
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:PARVEZ
Authorized Official - Last Name:BHIDYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-992-3000
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807
Mailing Address - Country:US
Mailing Address - Phone:865-992-3000
Mailing Address - Fax:865-992-7787
Practice Address - Street 1:2595 MAYNARDVILLE HWY
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807
Practice Address - Country:US
Practice Address - Phone:865-992-3000
Practice Address - Fax:865-992-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000025564174400000X
TNAPN0000008234363LF0000X
TNAPN0000006032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3378072Medicaid
TN3378072Medicare PIN
TNF95964Medicare UPIN