1568431393 NPI number — KENNETH W OLANDER M.D.

Table of content: KENNETH W OLANDER M.D. (NPI 1568431393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568431393 NPI number — KENNETH W OLANDER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLANDER
Provider First Name:
KENNETH
Provider Middle Name:
W
Provider Name Prefix Text:
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:
1568431393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1928 ALCOA HWY
Provider Second Line Business Mailing Address:
SUITE 324
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37920-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-524-9871
Provider Business Mailing Address Fax Number:
865-305-6695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
622 SMITHVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37803-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-681-1234
Provider Business Practice Location Address Fax Number:
865-982-9746
Provider Enumeration Date:
03/15/2006

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: 207W00000X , with the licence number:  029068 , 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: 0189280 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3812701 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0840032 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4016420 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180029273 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3063767 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100023403 . This is a "PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3333333 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: TN0112 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".




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