1831173137 NPI number — ATTENTUS OF SCOTT COUNTY, LLC

Table of content: (NPI 1831173137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831173137 NPI number — ATTENTUS OF SCOTT COUNTY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATTENTUS OF SCOTT COUNTY, LLC
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:
6
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:
1831173137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18797 ALBERTA STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONEIDA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-569-8521
Provider Business Mailing Address Fax Number:
423-569-2897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18797 ALBERTA STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONEIDA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-569-8521
Provider Business Practice Location Address Fax Number:
423-569-2897
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DUNCAN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
423-569-8521

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0000000101 , 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: 4099792 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0440052 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4099792 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 01601186 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000354657 . This is a "ANTHEM BCBS OF KY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: A3784111 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: A3784111 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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