MEDICARE: DR. THOMAS P JASELSKIS M.D.

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	207Q00000X	Family Medicine Physician	MD0000021081	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4041604	OTHER		BLUE CROSS BLUE SHIELD
2	2197543	OTHER	TN	AETNA

General Provider Information

NPI Number	:	1134122732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS P JASELSKIS M.D.

Provider Business Mailing Address
First Line	:	925 E BADDOUR PKWY
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-1703
Country	:	US
Telephone Number	:	615-444-5325
Fax Number	:	615-532-2785

Provider Business Practice Location Address
First Line	:	925 E BADDOUR PKWY
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-1703
Country	:	US
Telephone Number	:	615-444-5325
Fax Number	:	615-532-2785

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	09/12/2011

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