1891701645 NPI number — SUMMIT VIEW OF FARRAGUT, LLC

Table of content: (NPI 1891701645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891701645 NPI number — SUMMIT VIEW OF FARRAGUT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT VIEW OF FARRAGUT, 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:
Provider Other Organization Name Type Code:
6
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:
1891701645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37933-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-966-0600
Provider Business Mailing Address Fax Number:
865-675-6008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12823 KINGSTON PIKE
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:
37934-0920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-966-0600
Provider Business Practice Location Address Fax Number:
865-675-4154
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAWRENCE
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT, OWNER
Authorized Official Telephone Number:
865-675-6444

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 113709 . This is a "BCBS#" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7440449 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 044-5258 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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