1982087326 NPI number — HARVILLE ORTHODONTICS PLLC

Table of content: (NPI 1982087326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982087326 NPI number — HARVILLE ORTHODONTICS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARVILLE ORTHODONTICS PLLC
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:
1982087326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2025 MEADOWVIEW PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
KINGSPORT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37660-7386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-247-5137
Provider Business Mailing Address Fax Number:
423-392-8595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 MEADOWVIEW PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37660-7386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-247-5137
Provider Business Practice Location Address Fax Number:
423-392-8595
Provider Enumeration Date:
07/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HARVILLE
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
NOTTINGHAM
Authorized Official Title or Position:
ORTHODONTIST/OWNER
Authorized Official Telephone Number:
423-247-5137

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  9754 , 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: Q002056 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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