1891701645 NPI number — SUMMIT VIEW OF FARRAGUT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891701645 NPI number — SUMMIT VIEW OF FARRAGUT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT VIEW OF FARRAGUT, 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:
1891701645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22280
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:
37933-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-966-0600
Provider Business Mailing Address Fax Number:
865-675-6008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12823 KINGSTON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37934-0920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-966-0600
Provider Business Practice Location Address Fax Number:
865-675-4154
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAWRENCE
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT, OWNER
Authorized Official Telephone Number:
865-675-6444

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 113709 . This is a "BCBS#" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7440449 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 044-5258 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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