Organization
RIVERGATE PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY H EIDSON MD (VICE PRESIDENT)
(615) 859-6650
Entity
Organization
Contact information
Practice address
807 MEADOWLARK LN, GOODLETTSVILLE, TN 37072-2307
(615) 859-6650
(615) 851-1983
Mailing address
807 MEADOWLARK LN, GOODLETTSVILLE, TN 37072-2307
(615) 859-6650
(615) 851-1983
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000315
BCBS OF TN
—
05
—
3381850
—
TN
Enumeration date
09/22/2005
Last updated
01/25/2011
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