Healthcare Provider Details

I. General information

NPI: 1043672306
Provider Name (Legal Business Name): KNOX HOSPITAL COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E CULVER RD
KNOX IN
46534-2216
US

IV. Provider business mailing address

33371 COLLECTION CENTER DR
CHICAGO IL
60675-0333
US

V. Phone/Fax

Practice location:
  • Phone: 571-772-6231
  • Fax:
Mailing address:
  • Phone: 866-916-5259
  • Fax: 231-922-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MIKE SWAW
Title or Position: DIRECTOR
Credential:
Phone: 615-778-8076