Provider Demographics
NPI:1356531461
Name:B. B. LEDBETTER, M. D., PLC
Entity type:Organization
Organization Name:B. B. LEDBETTER, M. D., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:BUFORD
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:931-645-4200
Mailing Address - Street 1:1731 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4543
Mailing Address - Country:US
Mailing Address - Phone:931-645-4200
Mailing Address - Fax:931-645-4285
Practice Address - Street 1:1731 MEMORIAL DR
Practice Address - Street 2:SUITE 203
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4523
Practice Address - Country:US
Practice Address - Phone:931-645-4200
Practice Address - Fax:931-645-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD9047207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727863Medicare PIN
TN1356531461Medicare UPIN