1043462401 NPI number — KENT H. VAN ARSDELL, M.D.

Table of content: (NPI 1043462401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043462401 NPI number — KENT H. VAN ARSDELL, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENT H. VAN ARSDELL, M.D.
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:
1043462401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9217 PARK WEST BLVD
Provider Second Line Business Mailing Address:
SUITE C-3
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37923-4404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-693-9373
Provider Business Mailing Address Fax Number:
865-693-5368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9217 PARK WEST BLVD
Provider Second Line Business Practice Location Address:
SUITE C-3
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37923-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-693-9373
Provider Business Practice Location Address Fax Number:
865-693-5368
Provider Enumeration Date:
10/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VAN ARSDELL
Authorized Official First Name:
KENT
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
865-693-9373

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD025081 , 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: 3057214 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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