Provider Demographics
NPI:1124689450
Name:WEST KNOXVILLE MEDICAL P.L.L.C.
Entity type:Organization
Organization Name:WEST KNOXVILLE MEDICAL P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-621-6806
Mailing Address - Street 1:6216 HIGHLAND PLACE WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4068
Mailing Address - Country:US
Mailing Address - Phone:865-287-5904
Mailing Address - Fax:
Practice Address - Street 1:6216 HIGHLAND PLACE WAY STE 201
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4068
Practice Address - Country:US
Practice Address - Phone:896-287-5904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty