1134232184 NPI number — DOCTORS CARE OF TENNESSEE, P.C.

Table of content: (NPI 1134232184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134232184 NPI number — DOCTORS CARE OF TENNESSEE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS CARE OF TENNESSEE, P.C.
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:
DOCTORS CARE, PA
Provider Other Organization Name Type Code:
3
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:
1134232184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 63420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28263-3420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-758-2600
Provider Business Mailing Address Fax Number:
803-253-8896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 GLENLEIGH CT
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:
37934-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-675-3311
Provider Business Practice Location Address Fax Number:
865-675-3322
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GIBBONS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
803-782-4278

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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