1386735298 NPI number — UNIVERSITY OF TENNESSEE

Table of content: (NPI 1386735298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386735298 NPI number — UNIVERSITY OF TENNESSEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF TENNESSEE
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:
6
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:
1386735298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 MADISON AVE
Provider Second Line Business Mailing Address:
SUITE 415
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38163-2243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-448-6438
Provider Business Mailing Address Fax Number:
901-448-1411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE EC013
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38163-2243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-448-6438
Provider Business Practice Location Address Fax Number:
901-448-1411
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIKENS
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
COUNTS
Authorized Official Title or Position:
ASSOCIATE PROFESSOR AND CHAIRMAN
Authorized Official Telephone Number:
901-448-5047

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3133295 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0446645 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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