1134142086 NPI number — APEX KNOX LLC

Table of content: (NPI 1134142086)

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:
NEPHROLOGY CONSULTANTS
Provider Other Organization Name Type Code:
3
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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