Provider Demographics
NPI:1316492887
Name:REDMON FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:REDMON FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:REDMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-525-5134
Mailing Address - Street 1:PO BOX 31816
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-1816
Mailing Address - Country:US
Mailing Address - Phone:865-392-1888
Mailing Address - Fax:865-392-1889
Practice Address - Street 1:11408 KINGSTON PIKE
Practice Address - Street 2:STE 400
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3975
Practice Address - Country:US
Practice Address - Phone:865-392-1888
Practice Address - Fax:865-392-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ025396Medicaid
TNDW9211Medicare PIN
TNQ025396Medicaid