1518088814 NPI number — DR. MARTHA WIKE PH.D.

Table of content: DR. MARTHA WIKE PH.D. (NPI 1518088814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518088814 NPI number — DR. MARTHA WIKE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIKE
Provider First Name:
MARTHA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1518088814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 S CONCORD ST
Provider Second Line Business Mailing Address:
SUITE 114
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919-3306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-523-6273
Provider Business Mailing Address Fax Number:
865-523-7596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S CONCORD ST
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-523-6273
Provider Business Practice Location Address Fax Number:
865-523-7596
Provider Enumeration Date:
04/03/2007

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: 103T00000X , with the licence number:  P0000001710 , 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: 4128007 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com