1447341268 NPI number — THE NOWELL CORPORATION

Table of content: (NPI 1447341268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447341268 NPI number — THE NOWELL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE NOWELL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BEFITTING YOU MASTECTOMY BOUTIQUE THOMPSON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447341268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 HIGHWAY 321 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENOIR CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37771-5003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-988-0000
Provider Business Mailing Address Fax Number:
865-986-1542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1915 WHITE AVE
Provider Second Line Business Practice Location Address:
FLOOR 2
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-541-1452
Provider Business Practice Location Address Fax Number:
865-541-1453
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMASON
Authorized Official First Name:
CHASTITY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MEDICAL BILLING/DME SUPERVISOR
Authorized Official Telephone Number:
865-988-0000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4164496 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 702008365 . This is a "CARITEN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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