1669416921 NPI number — LORI A BAXTER M.D., FAAP

Table of content: LORI A BAXTER M.D., FAAP (NPI 1669416921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669416921 NPI number — LORI A BAXTER M.D., FAAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAXTER
Provider First Name:
LORI
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., FAAP
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:
1669416921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CEDAR CREEK PEDIATRIC & ADOLESCENT MEDICINE, PC
Provider Second Line Business Mailing Address:
616 SMITHVIEW DRIVE
Provider Business Mailing Address City Name:
MARYVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37803-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-379-2277
Provider Business Mailing Address Fax Number:
865-738-0087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CEDAR CREEK PEDIATRIC & ADOLESCENT MEDICINE, PC
Provider Second Line Business Practice Location Address:
616 SMITHVIEW DRIVE
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:
865-379-2277
Provider Business Practice Location Address Fax Number:
865-738-0087
Provider Enumeration Date:
06/16/2006

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: 208000000X , with the licence number:  MD21610 , 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: 3061228 . This is a "MEDICAID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: MD21610 . This is a "MEDICAL LICESNE NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".