Provider Demographics
NPI:1679772685
Name:JAMES D BOMBOY JR MD PC
Entity Type:Organization
Organization Name:JAMES D BOMBOY JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOMBOY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:615-292-8144
Mailing Address - Street 1:403 LYNNWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-3434
Mailing Address - Country:US
Mailing Address - Phone:615-292-8144
Mailing Address - Fax:615-217-8525
Practice Address - Street 1:2000 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236-0002
Practice Address - Country:US
Practice Address - Phone:615-284-6399
Practice Address - Fax:615-217-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8197207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN15779OtherBLUE CROSS
TN3382592Medicaid
TN3382592Medicare PIN
D70187Medicare UPIN