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General NPI Number Information
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NPI Number | 1407240971
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Entity Type | Organization
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Legal Business Name | KNOXVILLE OMNICARE, PLLC
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Dates
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Enumeration Date | 03/23/2015
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Last Update Date | 03/23/2015
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Provider Practice Location Address
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Address Line | 1924 ALCOA HWY
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City | KNOXVILLE
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State | TN
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Zip | 37920-1511
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Country | US
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Telephone | 865-305-5510
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 SOUTHBREEZE CIR
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City | KNOXVILLE
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State | TN
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Zip | 37919-8441
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Country | US
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Telephone | 865-934-8385
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER, FOUNDER
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Name | DR. RYAN ALEXANDER UNGER
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Credential | M.D.
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Telephone | 865-934-8385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 49026
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License Number State | TN
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