1891880415 NPI number — PM&R ASSOCIATES

Table of content: (NPI 1891880415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891880415 NPI number — PM&R ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PM&R 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:
1891880415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 580
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37777-0580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-330-9799
Provider Business Mailing Address Fax Number:
865-330-9759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6441 DEANE HILL DRIVE
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:
37919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-330-9799
Provider Business Practice Location Address Fax Number:
865-330-9759
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BELLNER
Authorized Official First Name:
LISA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
865-330-9799

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  35462 , 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: 0717787 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1508811 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100038261 . This is a "PHP TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5623220001 . This is a "CIGNA GOVERNMENT SERVICES" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7152403 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4104038 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 41663670 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".




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