1134142086 NPI number — APEX KNOX LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134142086 NPI number — APEX KNOX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APEX KNOX 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:
Provider Other Organization Name Type Code:
6
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:
1134142086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/18/2019
NPI Reactivation Date:
04/24/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 LAUREL AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-637-5186
Provider Business Mailing Address Fax Number:
865-637-8487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 LAUREL AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-637-5186
Provider Business Practice Location Address Fax Number:
865-637-8487
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
HEETESH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
615-403-6716

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  207RN0300X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3718861 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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