Provider Demographics
NPI:1740478486
Name:ERNEST G. BUCHANAN, IV, M.D., PC
Entity type:Organization
Organization Name:ERNEST G. BUCHANAN, IV, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:GROVER
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:931-528-7797
Mailing Address - Street 1:1101 NEAL ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0901
Mailing Address - Country:US
Mailing Address - Phone:931-528-7797
Mailing Address - Fax:931-372-0098
Practice Address - Street 1:1101 NEAL ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0901
Practice Address - Country:US
Practice Address - Phone:931-528-7797
Practice Address - Fax:931-372-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723418Medicaid
TN3723418Medicare PIN
TN3723418Medicaid