MEDICARE: MARK ARDEN PIERCE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	MD20983	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4352435	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1053388561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ARDEN PIERCE MD

Provider Business Mailing Address
First Line	:	140 W 7TH ST
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-1726
Country	:	US
Telephone Number	:	931-783-5582
Fax Number	:	931-526-6760

Provider Business Practice Location Address
First Line	:	145 W 4TH ST
Second Line	:	SUITE 201
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-2447
Country	:	US
Telephone Number	:	931-783-2902
Fax Number	:	931-783-2219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	05/27/2022

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