1588612907 NPI number — JON SIMPSON PARHAM DO, MPH

Table of content: JON SIMPSON PARHAM DO, MPH (NPI 1588612907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588612907 NPI number — JON SIMPSON PARHAM DO, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARHAM
Provider First Name:
JON
Provider Middle Name:
SIMPSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO, MPH
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:
1588612907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1924 ALCOA HWY
Provider Second Line Business Mailing Address:
U-67
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37920-1511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-544-9352
Provider Business Mailing Address Fax Number:
865-544-9314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1924 ALCOA HWY
Provider Second Line Business Practice Location Address:
U-110
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37920-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-544-9351
Provider Business Practice Location Address Fax Number:
865-544-9314
Provider Enumeration Date:
05/05/2006

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: 207Q00000X , with the licence number:  DO534 , 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: TN01G3 . This is a "JOHN DEERE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3049827 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3304482 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3304484 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1689631137 . This is a "GROUP NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 01-41253 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100011026 . This is a "PHP TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 595988 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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