Individual
VIJAYA R. THEKKEURUMBIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 NORTHCREST DR, SPRINGFIELD, TN 37172-3927
(615) 384-2411
Mailing address
PO BOX 633819, CINCINNATI, OH 45263-0001
(865) 292-3000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34848
TN
208M00000X
Hospitalist Physician
44167
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10015751
OMNICARE TENNCARE
TN
01
—
21060
TLC TENNCARE
TN
05
—
3862507
—
TN
05
—
3862508
—
TN
05
—
3862509
—
TN
01
—
4001211
BLUE CROSS
TN
01
—
4013849
BLUE CROSS
TN
01
—
50004635
PASSPORT HEALTH PLAN
KY
05
—
64029556
—
KY
01
—
930113083
MEDICARE RAILROAD
TN
01
—
P00186020
MEDICARE RAILROAD
TN
01
—
P00384333
MEDICARE RAILROAD
TN
Enumeration date
06/19/2006
Last updated
10/07/2019
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