Provider Demographics
NPI:1295922961
Name:TERRY M. BINGHAM, MD, PC
Entity type:Organization
Organization Name:TERRY M. BINGHAM, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-882-2442
Mailing Address - Street 1:1855 TANNER WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8302
Mailing Address - Country:US
Mailing Address - Phone:865-882-2442
Mailing Address - Fax:865-882-0251
Practice Address - Street 1:2415 N GATEWAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8609
Practice Address - Country:US
Practice Address - Phone:865-882-2442
Practice Address - Fax:865-882-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000010262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1740063OtherUNITED HEALTHCARE
TN0014290OtherBLUE CROSS OF TN
TN020000758OtherRAILROAD MEDICARE
TNTN0101OtherJOHN DEERE
TN3184557Medicare PIN