1720382336 NPI number — MEN'S HEALTH MANAGEMENT OF EAST TENNESSEE

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 1720382336 NPI number — MEN'S HEALTH MANAGEMENT OF EAST TENNESSEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEN'S HEALTH MANAGEMENT OF EAST TENNESSEE
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:
1720382336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9724 KINGSTON PIKE
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37922-3347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-690-0602
Provider Business Mailing Address Fax Number:
865-690-0515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10820 PARKSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37934-1956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-690-0602
Provider Business Practice Location Address Fax Number:
865-690-0515
Provider Enumeration Date:
12/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTHORN
Authorized Official First Name:
JIM
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
865-690-0602

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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