1821199571 NPI number — DR. RICHARD M KNAPP M.D.

Table of content: DR. RICHARD M KNAPP M.D. (NPI 1821199571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821199571 NPI number — DR. RICHARD M KNAPP M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNAPP
Provider First Name:
RICHARD
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1821199571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 WHITETAIL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEALE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36875-5917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-384-1708
Provider Business Mailing Address Fax Number:
615-234-3762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 WHITETAIL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEALE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36875-5917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-384-1708
Provider Business Practice Location Address Fax Number:
615-234-3762
Provider Enumeration Date:
09/26/2006

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: 207ZP0102X , with the licence number:  33968 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282N00000X , with the licence number: 32223 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: MD.30846 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000018792 . This is a "TLC TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100031094 . This is a "PHP TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3850367 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52022505005 . This is a "BLUE CROSS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 006601294 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119582 . This is a "UNISON TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 89063F3 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 286997 . This is a "BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3143364 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 319800 . This is a "WELLCARE MEDCAID CMO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 64057102 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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