1508954959 NPI number — MR. CHRISTOPHER BRIAN OVERBAY PA

Table of content: MR. CHRISTOPHER BRIAN OVERBAY PA (NPI 1508954959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508954959 NPI number — MR. CHRISTOPHER BRIAN OVERBAY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OVERBAY
Provider First Name:
CHRISTOPHER
Provider Middle Name:
BRIAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1508954959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23740
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37933-1740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-549-4340
Provider Business Mailing Address Fax Number:
865-549-4341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10820 PARKSIDE DRIVE
Provider Second Line Business Practice Location Address:
BAPTIST HOSPITAL WEST DEPT OF SURGERY
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-218-7165
Provider Business Practice Location Address Fax Number:
865-218-7170
Provider Enumeration Date:
10/11/2006

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:  PA9110557 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA723 , 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: 4167585 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3704598 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4020004 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0163 . This is a "UHC - JOHN DEERE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3665185 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3668134 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102453300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com