1750374476 NPI number — CHARLES G SEWALL M.D.

Table of content: CHARLES G SEWALL M.D. (NPI 1750374476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750374476 NPI number — CHARLES G SEWALL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEWALL
Provider First Name:
CHARLES
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1750374476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 OAK RIDGE TPKE
Provider Second Line Business Mailing Address:
SUITE C-100
Provider Business Mailing Address City Name:
OAK RIDGE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37830-6957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-483-2288
Provider Business Mailing Address Fax Number:
865-482-4400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 OAK RIDGE TPKE
Provider Second Line Business Practice Location Address:
SUITE C-100
Provider Business Practice Location Address City Name:
OAK RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37830-6957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-483-2288
Provider Business Practice Location Address Fax Number:
865-482-4400
Provider Enumeration Date:
08/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207YX0007X , with the licence number:  28475 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YX0007X , with the licence number: 021441 , 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: 62089728903 . This is a "UHC RIVER VALLEY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000252844 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100020676 . This is a "PHP TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3059927 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 620897289002 . This is a "BLUEGRASS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4666257 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: C10003 . This is a "CUMBERLAND HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64799125 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3028800 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4532 . This is a "CHA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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