1861543910 NPI number — NEPHROLOGY ASSOCIATES OF KNOXVILLE

Table of content: (NPI 1861543910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861543910 NPI number — NEPHROLOGY ASSOCIATES OF KNOXVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROLOGY ASSOCIATES OF KNOXVILLE
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:
1861543910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3734 MARTIN MILL PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-380-0803
Provider Business Mailing Address Fax Number:
865-380-0609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1851 CREST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37804-4304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-380-0803
Provider Business Practice Location Address Fax Number:
865-380-0609
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERS
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
865-546-9246

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com