Provider Demographics
NPI:1689917759
Name:BLUFF CITY OBSTETRICS AND GYNECOLOGY
Entity Type:Organization
Organization Name:BLUFF CITY OBSTETRICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-512-6082
Mailing Address - Street 1:7796 WOLF TRAIL CV STE 202
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1783
Mailing Address - Country:US
Mailing Address - Phone:901-512-6086
Mailing Address - Fax:866-230-7816
Practice Address - Street 1:7796 WOLF TRAIL CV STE 202
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1783
Practice Address - Country:US
Practice Address - Phone:901-512-6086
Practice Address - Fax:866-230-7816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4347603OtherBCBS
TN10370G5229Medicare PIN