=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386675106
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEAM PHYSICIANS OF OHIO, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 07/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1431 CENTERPOINT BLVD SUITE 100
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37932-1984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-985-7185
-----------------------------------------------------
Fax | 865-560-7379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P O BOX 634769
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45263-4769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-985-7185
-----------------------------------------------------
Fax | 865-692-3390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR VICE PRESIDENT
-----------------------------------------------------
Name | DAVID ALAN TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-985-7180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------