1568536126 NPI number — DR. TIMOTHY E KNIGHT M.D.

Table of content: DR. TIMOTHY E KNIGHT M.D. (NPI 1568536126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568536126 NPI number — DR. TIMOTHY E KNIGHT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNIGHT
Provider First Name:
TIMOTHY
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1568536126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6500 N SOCRUM LOOP RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33809-4179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-853-3331
Provider Business Mailing Address Fax Number:
863-853-3337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 N SOCRUM LOOP RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33809-4308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-853-3331
Provider Business Practice Location Address Fax Number:
863-853-3337
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  ME86288 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1716600 . This is a "AETNA - HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 62853 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 265978600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DG5508 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2122854621301 . This is a "BEECHSTREET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 03-00964 . This is a "UHC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P0044110 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 08166 . This is a "UNIVERSAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 11246701 . This is a "CITRUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7988417 . This is a "AETNA - TRADITIONAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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