Healthcare Provider Details

I. General information

NPI: 1740314202
Provider Name (Legal Business Name): PEDIATRIC GASTROENTEROLOGY AND NUTRITIONAL SUPPORT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CLINCH AVE SUITE 230
KNOXVILLE TN
37916-2219
US

IV. Provider business mailing address

2100 W CLINCH AVE SUITE 230
KNOXVILLE TN
37916-2219
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-4116
  • Fax:
Mailing address:
  • Phone: 865-522-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: CORY T STRPBEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 865-522-4116