1023092426 NPI number — MPS-CARDIOLOGY LLC

Table of content: (NPI 1023092426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023092426 NPI number — MPS-CARDIOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MPS-CARDIOLOGY LLC
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:
EAST TENNESSEE HEART CONSULTANTS, P.C.
Provider Other Organization Name Type Code:
4
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:
1023092426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1225 E WEISGARBER RD
Provider Second Line Business Mailing Address:
SUITE 190
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37909-2604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-602-6700
Provider Business Mailing Address Fax Number:
865-602-6801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 E WEISGARBER RD
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37909-2604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-602-6700
Provider Business Practice Location Address Fax Number:
865-602-6801
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MINTEER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN OF THE BOARD
Authorized Official Telephone Number:
865-525-6688

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 65917767 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890191K , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100120510 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3380219 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1519407 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0373251 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 905861300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com