1306864186 NPI number — KNOXVILLE KIDNEY CENTER, PLLC

Table of content: (NPI 1306864186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306864186 NPI number — KNOXVILLE KIDNEY CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KNOXVILLE KIDNEY CENTER, PLLC
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:
G. EDWARD NEWMAN, MD, PLLC
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:
1306864186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 PARK 40 NORTH BLVD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37923-3624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-692-3462
Provider Business Mailing Address Fax Number:
865-692-3463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 PARK 40 NORTH BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37923-3624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-692-3462
Provider Business Practice Location Address Fax Number:
865-692-3463
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONGER
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
865-692-3462

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QH0100X , with the licence number: 32138 , 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: 004125050 . This is a "BLUECROSS BLUESHIELD OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: DE8488 . This is a "PGBA RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com