MEDICARE: DR. IRA A SHIVITZ 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	174400000X	Specialist	15763	TN
2	207W00000X	Ophthalmology Physician	MD15763	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	180036789	OTHER	TN	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	621745543	OTHER	TN	HUMANA
2	0627781	OTHER	TN	CIGNA
3	0840173	OTHER	TN	UNITED HEALTHCARE
4	00001364	OTHER	TN	NHC HEALTH BENEFIT PLAN
5	2150030	OTHER	TN	AETNA
6	3126360	OTHER	TN	TENNCARE SELECT
7	3126360	OTHER	TN	ACCORDIA OF LEXINGTON
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	B58858	OTHER	TN	HEALTHSPRING
11	3126360	OTHER	TN	BCBS
12	621745543000	OTHER	TN	PRUDENTIAL

General Provider Information

NPI Number	:	1881690766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA A SHIVITZ MD

Provider Business Mailing Address
First Line	:	335 24TH AVE N STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1503
Country	:	US
Telephone Number	:	615-320-7200
Fax Number	:	615-320-7203

Provider Business Practice Location Address
First Line	:	335 24TH AVE N STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1503
Country	:	US
Telephone Number	:	615-320-7200
Fax Number	:	615-320-7203

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	12/19/2024

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