MEDICARE: SAMUEL MARK OVERHOLT 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	207Y00000X	Otolaryngology Physician	28826	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417952482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL MARK OVERHOLT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 31547
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37930-1547
Country	:	US
Telephone Number	:	865-693-6065
Fax Number	:	865-531-6325

Provider Business Practice Location Address
First Line	:	9430 PARK WEST BLVD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4200
Country	:	US
Telephone Number	:	865-693-6065
Fax Number	:	865-531-6325

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/05/2007

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