Provider Demographics
NPI:1902022874
Name:KNOXVILLE INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:KNOXVILLE INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADM
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-632-5885
Mailing Address - Street 1:101 E BLOUNT AVE
Mailing Address - Street 2:SUITE 740
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1601
Mailing Address - Country:US
Mailing Address - Phone:865-632-5885
Mailing Address - Fax:865-632-5893
Practice Address - Street 1:101 E BLOUNT AVE
Practice Address - Street 2:SUITE 740
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1632
Practice Address - Country:US
Practice Address - Phone:865-632-5885
Practice Address - Fax:865-632-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN293835OtherFED BLACK LUNG
TN3707980Medicaid
TN=========OtherTAX ID NUMBER
TN3707980Medicare ID - Type UnspecifiedMEDICARE