1205957099 NPI number — MARK HOWARD P.A.

Table of content: MARK HOWARD P.A. (NPI 1205957099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205957099 NPI number — MARK HOWARD P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWARD
Provider First Name:
MARK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1205957099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1932 ALCOA HWY
Provider Second Line Business Mailing Address:
STE 270
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37920-1537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-251-4658
Provider Business Mailing Address Fax Number:
865-251-4659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 E OAK HILL AVE
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:
37917-4505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-539-8018
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2007

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: 363A00000X , with the licence number:  1513 , 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: P00416340 . This is a "RAILROAD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4158319 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 114936200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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