Provider Demographics
NPI:1912918343
Name:PRIBANICH, STEVEN (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:PRIBANICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 LIVINGSTON RD
Mailing Address - Street 2:SUITE 101, PMB #49
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6740
Mailing Address - Country:US
Mailing Address - Phone:931-484-7675
Mailing Address - Fax:931-484-3045
Practice Address - Street 1:57 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4836
Practice Address - Country:US
Practice Address - Phone:931-484-7675
Practice Address - Fax:931-484-3045
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34621207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38586451OtherMEDICARE
TN4231180OtherBCBS
TN38586451OtherMEDICARE