Provider Demographics
NPI:1588657977
Name:FAMILY AND SPORTS MEDICINE PC
Entity type:Organization
Organization Name:FAMILY AND SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-870-2030
Mailing Address - Street 1:1025 EXECUTIVE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-7916
Mailing Address - Country:US
Mailing Address - Phone:423-870-2030
Mailing Address - Fax:423-875-6405
Practice Address - Street 1:1025 EXECUTIVE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7916
Practice Address - Country:US
Practice Address - Phone:423-870-2030
Practice Address - Fax:423-875-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3053865Medicaid
TN3168293Medicaid
TN3082742Medicaid
B03272Medicare UPIN
TN3053865Medicaid
TNC68858Medicare UPIN
TN3304630Medicare PIN
TN3082749Medicare PIN
TNF51312Medicare UPIN
TNF81240Medicare UPIN
TN3082742Medicaid
TN3720420Medicare PIN