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1972084069 NPI number — EDMUNDS GASTROENTEROLOGY, PLLC

NPI Number: 1972084069
Health Care Provider/Practitioner: EDMUNDS GASTROENTEROLOGY, PLLC

Information about “1972084069” NPI (EDMUNDS GASTROENTEROLOGY, PLLC) exists in 1972084069 in HTML format HTML  |  1972084069 in plain Text format TXT  |  1972084069 in PDF (Portable Document Format) PDF  |  1972084069 in an XML format XML  formats.

NPI Number : 1972084069 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972084069",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "EDMUNDS GASTROENTEROLOGY, PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4713 PAPERMILL DR STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KNOXVILLE",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37909-1924",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "865-851-7771",
    "MailingAddressFaxNumber": "865-851-7835",
    "FirstLinePracticeLocationAddress": "4713 PAPERMILL DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KNOXVILLE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37909-1908",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "865-851-7771",
    "PracticeLocationAddressFaxNumber": "865-851-7835",
    "EnumerationDate": "08/27/2018",
    "LastUpdateDate": "08/09/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JENKINS",
    "AuthorizedOfficialFirstName": "PAT",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CREDENTIALING SPECIALIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "865-740-1095",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RG0100X",
        "TaxonomyName": "Gastroenterology Physician",
        "LicenseNumber": "MD26426",
        "LicenseNumberStateCode": "TN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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