=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598717126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENAL MEDICAL ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2006
-----------------------------------------------------
Last Update Date | 03/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 939 EMERALD AVE SUITE 610
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37917-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-637-8635
-----------------------------------------------------
Fax | 865-637-4821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 939 EMERALD AVE SUITE 610
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37917-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-637-8635
-----------------------------------------------------
Fax | 865-637-4821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. JUDY THOMPSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-637-8635
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------