1548291305 NPI number — TEAM PHYSICIANS OF CONNECTICUT, PC

Table of content: TINA PHOUSOUVANH HANSON MA (NPI 1083982094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548291305 NPI number — TEAM PHYSICIANS OF CONNECTICUT, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEAM PHYSICIANS OF CONNECTICUT, PC
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:
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:
1548291305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 636016
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-6016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-985-7185
Provider Business Mailing Address Fax Number:
865-692-3390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431 CENTERPOINT BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37932-1984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-985-7185
Provider Business Practice Location Address Fax Number:
865-560-7379
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
865-985-7180

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004223541-P1 . This is a "BLUECARE FAMILY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 202902 . This is a "PREFERRED ONE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: A2721965 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 500HBX449CT01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: DA2718 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V2254 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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