1982192076 NPI number — DR. WILLIAM TAYLOR RIDEN DO

Table of content: DR. WILLIAM TAYLOR RIDEN DO (NPI 1982192076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982192076 NPI number — DR. WILLIAM TAYLOR RIDEN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIDEN
Provider First Name:
WILLIAM
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1982192076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 ACCELERATOR WAY STE 200
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:
37920-3078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-546-2663
Provider Business Mailing Address Fax Number:
865-546-9047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 ACCELERATOR WAY STE 200
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:
37920-3078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-546-2663
Provider Business Practice Location Address Fax Number:
865-546-9047
Provider Enumeration Date:
04/25/2018

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: 208100000X , with the licence number:  4656 , 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)