1700892429 NPI number — TRAIL OF THE CUMBERLANDS ANESTHESIA ASSOCIATES

Table of content: (NPI 1700892429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700892429 NPI number — TRAIL OF THE CUMBERLANDS ANESTHESIA ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRAIL OF THE CUMBERLANDS ANESTHESIA ASSOCIATES
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:
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:
1700892429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 COX HOLLOW RD
Provider Second Line Business Mailing Address:
TRAIL OF THE CUMBERLANDS ANESTHESIA ASSOCIATES
Provider Business Mailing Address City Name:
KINGSPORT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37663-3150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-349-4319
Provider Business Mailing Address Fax Number:
423-349-0799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 OLD KNOXVILLE HWY
Provider Second Line Business Practice Location Address:
CLAIBORNE COUNTY HOSPITAL
Provider Business Practice Location Address City Name:
TAZEWELL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-626-4211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RENDER
Authorized Official First Name:
GARY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
423-349-4314

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3629220 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".