1679578538 NPI number — DR. THOMAS E MCKNIGHT JR. D.O. MPH

Table of content: DR. THOMAS E MCKNIGHT JR. D.O. MPH (NPI 1679578538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679578538 NPI number — DR. THOMAS E MCKNIGHT JR. D.O. MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKNIGHT
Provider First Name:
THOMAS
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.O. MPH
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:
1679578538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
236 W EAST AVE
Provider Second Line Business Mailing Address:
PMB 104
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95926-7235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-896-0260
Provider Business Mailing Address Fax Number:
530-896-0287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 INDEPENDENCE CIR
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95973-4962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-896-0260
Provider Business Practice Location Address Fax Number:
530-896-0287
Provider Enumeration Date:
06/16/2005

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: 2084N0400X , with the licence number:  20A4876 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 20A4876 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0008X , with the licence number: 20A4876 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X , with the licence number: 20A4876 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00AX48760 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130026036 . This is a "MEDICARE RAILROAD #" identifier . This identifiers is of the category "OTHER".