MEDICARE: DR. ERIC R NICELY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	MD0000019805	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CI2260	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1669416442	OTHER	TN	GROUP NPI
2	3106070	OTHER	TN	BLUE CROSS
4	3106086	OTHER	TN	BLUE CROSS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043210164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC R NICELY M.D.

Provider Business Mailing Address
First Line	:	9724 KINGSTON PIKE
Second Line	:	SUITE 800
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-3347
Country	:	US
Telephone Number	:	865-690-0602
Fax Number	:	865-690-0515

Provider Business Practice Location Address
First Line	:	7557 DANNAHER LN
Second Line	:	SUITE 230
City	:	POWELL
State	:	TN
Zip	:	37849-3558
Country	:	US
Telephone Number	:	865-637-9431
Fax Number	:	865-637-8887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	12/07/2007

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Directions to “ DR. ERIC R NICELY M.D.” Practice Location

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