1568548006 NPI number — MR. NICHOLAS PETER XENOPOULOS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568548006 NPI number — MR. NICHOLAS PETER XENOPOULOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
XENOPOULOS
Provider First Name:
NICHOLAS
Provider Middle Name:
PETER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
XENOPOULOS
Provider Other First Name:
NICHOLAOS
Provider Other Middle Name:
PETER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568548006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9330 PARK WEST BLVD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37923-4308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-691-4850
Provider Business Mailing Address Fax Number:
865-539-5073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9330 PARK WEST BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37923-4308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-691-4850
Provider Business Practice Location Address Fax Number:
865-539-5073
Provider Enumeration Date:
10/27/2006

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: 207RC0000X , with the licence number:  32179 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 01046596A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 39685 , 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: 25-00486 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000112862 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200106000 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3154073 . This is a "BCBS TENNESSEE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5156752 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7233954008 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060058270 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1166305 . This is a "CHA PROVIDER NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 299856 . This is a "FEDERAL BLACK LUNG PROGRA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1116387 . This is a "PASSPORT HEALTH PLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6113371060A12 . This is a "ANTHEM SR. ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64321797 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 415632P . This is a "SIHO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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