1720073810 NPI number — UNIVERSITY ORTHOPEDIC CLINIC

Table of content: (NPI 1720073810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720073810 NPI number — UNIVERSITY ORTHOPEDIC CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY ORTHOPEDIC CLINIC
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:
1720073810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 19TH ST
Provider Second Line Business Mailing Address:
SUITE 601
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37916-1854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-521-7662
Provider Business Mailing Address Fax Number:
865-541-2895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 19TH ST
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-1854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-521-7662
Provider Business Practice Location Address Fax Number:
865-541-2895
Provider Enumeration Date:
09/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DEGNAN
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
865-521-7662

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD020653 , 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: 166410400 . This is a "U.S. DEPT. OF LABOR PROV." identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 21159366 . This is a "WAUSAU PROVIDER #" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 121659 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com