1932318284 NPI number — TENNESSEE UROLOGY ASSOCIATES, PLLC

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 1932318284 NPI number — TENNESSEE UROLOGY ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENNESSEE UROLOGY ASSOCIATES, PLLC
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:
1932318284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 CROSSROADS DR STE 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-5437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-690-0602
Provider Business Mailing Address Fax Number:
865-690-0515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7557 DANNAHER WAY
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
POWELL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37849-3558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-938-5222
Provider Business Practice Location Address Fax Number:
865-938-5264
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIMPSON
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER ENROLLMENT MANAGER
Authorized Official Telephone Number:
720-381-2805

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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