MEDICARE: DR. W JAN KAZMIER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD0000016939	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110024502	OTHER	TN	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0078009	OTHER	TN	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	079672	OTHER	VA	ANTHEM BCBS
5	01-41828	OTHER	TN	UNITED HEALTHCARE
6	TN0101	OTHER	TN	JOHN DEERE HEALTH
7	621482794	OTHER		TAX ID
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	100010179	OTHER	TN	PHP TENNESSEE

General Provider Information

NPI Number	:	1235197815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. W JAN KAZMIER M.D.

Provider Business Mailing Address
First Line	:	2995 FORT HENRY DR
Second Line	:	SUITE 100
City	:	KINGSPORT
State	:	TN
Zip	:	37664-4005
Country	:	US
Telephone Number	:	423-246-6445
Fax Number	:	423-246-8240

Provider Business Practice Location Address
First Line	:	2995 FORT HENRY DR
Second Line	:	SUITE 100
City	:	KINGSPORT
State	:	TN
Zip	:	37664-4005
Country	:	US
Telephone Number	:	423-246-6445
Fax Number	:	423-246-8240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/18/2013

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