1801892195 NPI number — MR. ERIC H ROCKWELL PT

Table of content: MR. ERIC H ROCKWELL PT (NPI 1801892195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801892195 NPI number — MR. ERIC H ROCKWELL PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROCKWELL
Provider First Name:
ERIC
Provider Middle Name:
H
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1801892195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/15/2006
NPI Reactivation Date:
03/20/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6700 BAUM DRIVE
Provider Second Line Business Mailing Address:
STE 19
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919-7334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-588-4108
Provider Business Mailing Address Fax Number:
865-474-1521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6700 BAUM DRIVE
Provider Second Line Business Practice Location Address:
STE 19
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919-7334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-588-4108
Provider Business Practice Location Address Fax Number:
865-474-1521
Provider Enumeration Date:
06/22/2005

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: 225100000X , with the licence number:  PT762 , 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: 650008552 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2005539 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0101 . This is a "JOHN DEERE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3654677 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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