=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720099708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY PHYSICIANS OF GREENEVILLE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2006
-----------------------------------------------------
Last Update Date | 05/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1410 TUSCULUM BLVD SUITE 2600
-----------------------------------------------------
City | GREENEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37745-5819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-787-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1410 TUSCULUM BLVD SUITE 2600
-----------------------------------------------------
City | GREENEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37745-5819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-787-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | DR. KEVIN S TOPPENBERG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 423-787-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 30267
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------