1821092453 NPI number — DR. STEPHEN M. TREON MD,PHD

Table of content: DR. STEPHEN M. TREON MD,PHD (NPI 1821092453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821092453 NPI number — DR. STEPHEN M. TREON MD,PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TREON
Provider First Name:
STEPHEN
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD,PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TREON
Provider Other First Name:
STEPHEN
Provider Other Middle Name:
MARSHAL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1821092453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1107
Provider Second Line Business Mailing Address:
141 OCOEE
Provider Business Mailing Address City Name:
COPPERHILL
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37317-1107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-496-4103
Provider Business Mailing Address Fax Number:
423-496-4106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 OCOEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COPPERHILL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-496-4103
Provider Business Practice Location Address Fax Number:
423-496-4106
Provider Enumeration Date:
06/10/2005

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: 207RR0500X , with the licence number:  MD0000024711 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD0000024711 , 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: 169300 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 85000174G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00540383A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 169300 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 890693W , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4415141 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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