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General NPI Number Information
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NPI Number | 1013310762
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Entity Type | Organization
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Legal Business Name | KNOXVILLE INTEGRATIVE MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 9313 S NORTHSHORE DR
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City | KNOXVILLE
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State | TN
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Zip | 37922-6548
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Country | US
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Telephone | 865-531-6454
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Fax |
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Provider Business Mailing Address
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Address Line | 9313 S NORTHSHORE DR
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City | KNOXVILLE
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State | TN
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Zip | 37922-6548
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Country | US
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Telephone | 865-531-6454
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEVIN STASNEY
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Credential | M.D.
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Telephone | 865-531-6454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 37682
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2302
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24689
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License Number State | TN
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