=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841209848
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEN STRICKS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2006
-----------------------------------------------------
Last Update Date | 11/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 SAINT MICHAELS DR
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87505-7601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-989-6130
-----------------------------------------------------
Fax | 505-820-5408
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5410 MARYLAND WAY SUITE
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-5064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-377-5670
-----------------------------------------------------
Fax | 615-377-1678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD20040053
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------