MEDICARE: SAMUEL R BASTIAN 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	207R00000X	Internal Medicine Physician	MD21179	TN
2	208000000X	Pediatrics Physician	MD21179	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

General Provider Information

NPI Number	:	1851382568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL R BASTIAN M.D.

Provider Business Mailing Address
First Line	:	222 22ND AVE N
Second Line	:	SUITE 100
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1852
Country	:	US
Telephone Number	:	615-284-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2339 HILLSBORO RD
Second Line	:	SUITE 100
City	:	FRANKLIN
State	:	TN
Zip	:	37069-6225
Country	:	US
Telephone Number	:	615-224-1970
Fax Number	:	615-916-3946

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	01/27/2016

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