1497755458 NPI number — DR. JEFF E FLICKINGER M.D.

Table of content: DR. JEFF E FLICKINGER M.D. (NPI 1497755458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497755458 NPI number — DR. JEFF E FLICKINGER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLICKINGER
Provider First Name:
JEFF
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1497755458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 LAUREL AVE
Provider Second Line Business Mailing Address:
SUITE 502
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37916-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-331-9000
Provider Business Mailing Address Fax Number:
865-331-7000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 LAUREL AVE
Provider Second Line Business Practice Location Address:
SUITE 502
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-331-9000
Provider Business Practice Location Address Fax Number:
865-331-7000
Provider Enumeration Date:
07/29/2005

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: 208800000X , with the licence number:  MD0000024828 , 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: 1669416442 . This is a "GROUP NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 020252399 . This is a "EEOICP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3813049 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3106057 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3106069 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: CI2260 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com