Provider Demographics
NPI:1699972901
Name:KNOXVILLE CONSULTANTS IN GASTROENTEROLOGY PC
Entity type:Organization
Organization Name:KNOXVILLE CONSULTANTS IN GASTROENTEROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-531-8294
Mailing Address - Street 1:9349 PARK WEST BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4306
Mailing Address - Country:US
Mailing Address - Phone:865-531-8294
Mailing Address - Fax:
Practice Address - Street 1:9349 PARK WEST BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4306
Practice Address - Country:US
Practice Address - Phone:865-531-8294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD008974207RG0100X
TNMD018257207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702710Medicaid
TN0095407OtherBLUE CROSS
TN0131138OtherBLUE CROSS
TN3702710Medicare ID - Type Unspecified
TNF09638Medicare UPIN
TN3702710Medicaid