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NPI Code Detail

MEDICARE: MR. JUSTIN LUKE BOREN PA

MEDICARE: MR. JUSTIN LUKE BOREN PA
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
1363A00000XPhysician AssistantPA1296TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00382564OTHERTNRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
54142242OTHERTNBLUE CROSS

General Provider Information

NPI Number : 1053468199
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JUSTIN LUKE BOREN PA
Provider Business Mailing Address
First Line : 410 42ND AVE N STE 400
Second Line :
City : NASHVILLE
State : TN
Zip : 37209-3658
Country : US
Telephone Number : 615-329-7887
Fax Number :
Provider Business Practice Location Address
First Line : 832 WESTOVER DR STE 200
Second Line :
City : COLUMBIA
State : TN
Zip : 38401-4843
Country : US
Telephone Number : 931-830-3033
Fax Number : 931-388-3401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 08/15/2023

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Directions to “ MR. JUSTIN LUKE BOREN PA” Practice Location

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