1063442333 NPI number — UNIVERSITY SURGEONS ASSOCIATES

Table of content: DR. JOSEPH PETER CRAVERO MD (NPI 1689604985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063442333 NPI number — UNIVERSITY SURGEONS ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY SURGEONS 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:
1063442333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1924 ALCOA HWY
Provider Second Line Business Mailing Address:
BOX U-11
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37920-6999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-305-9620
Provider Business Mailing Address Fax Number:
865-525-3460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 ALCOA HWY BLDG A
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37920-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-305-9620
Provider Business Practice Location Address Fax Number:
865-525-3460
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIGGENBACH
Authorized Official First Name:
CHARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
865-305-9620

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3717505 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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