Healthcare Provider Details

I. General information

NPI: 1568576775
Provider Name (Legal Business Name): TIMOTHY M HENSCHEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 GATEWAY BLVD. SUITE 110
MURFREESBORO TN
37129
US

IV. Provider business mailing address

1370 GATEWAY BLVD. SUITE 110
MURFREESBORO TN
37129
US

V. Phone/Fax

Practice location:
  • Phone: 615-890-9008
  • Fax: 615-890-0193
Mailing address:
  • Phone: 615-790-0567
  • Fax: 615-595-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30632
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3132045
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier3898088
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer
# 3
Identifier4384713
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerAETNA
# 4
Identifier9381502
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerCIGNA
# 5
Identifier1240364
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerUNITED HEALTHCARE
# 6
Identifier30632
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerMEDICAL LICENSE #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: