Provider Demographics
NPI:1144655853
Name:RUTHERFORD PERINATAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:RUTHERFORD PERINATAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYOR-LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-957-9027
Mailing Address - Street 1:9204 SHERIDAN PARK CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1748
Mailing Address - Country:US
Mailing Address - Phone:613-957-9027
Mailing Address - Fax:
Practice Address - Street 1:9204 SHERIDAN PARK CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1748
Practice Address - Country:US
Practice Address - Phone:613-957-9027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD44564207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510618Medicaid