1639405483 NPI number — CAMPBELL CUNNINGHAM TAYLOR PC

Table of content: (NPI 1639405483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639405483 NPI number — CAMPBELL CUNNINGHAM TAYLOR PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMPBELL CUNNINGHAM TAYLOR PC
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:
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:
1639405483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
628 SMITHVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37803-6100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-984-7012
Provider Business Mailing Address Fax Number:
865-981-4401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
628 SMITHVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37803-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-984-7012
Provider Business Practice Location Address Fax Number:
865-981-4401
Provider Enumeration Date:
10/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARRISON
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CREDENTIALS COORDINATOR
Authorized Official Telephone Number:
865-584-2127

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  MD016011 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: MD021400 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: MD0034217 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: MD0008625 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: MD029986 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: OD001240 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: OD002250 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 645010002 . This is a "DME" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3371152 . This is a "MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3371152 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".