1770591323 NPI number — JOHN H STUHL

Table of content: JOHN H STUHL (NPI 1770591323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770591323 NPI number — JOHN H STUHL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUHL
Provider First Name:
JOHN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1770591323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1694
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWELL
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37849-1694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-947-9113
Provider Business Mailing Address Fax Number:
865-947-9146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 STEKOIA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37912-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-947-9113
Provider Business Practice Location Address Fax Number:
865-675-4853
Provider Enumeration Date:
08/03/2006

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: 103TC1900X , with the licence number:  P000002053 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TB0200X , with the licence number: P0000002053 , 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: 3688805 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3044251 . This is a "BC/BS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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