Provider Demographics
NPI:1093759284
Name:UNIVERSITY HEART SURGEONS PLLC
Entity Type:Organization
Organization Name:UNIVERSITY HEART SURGEONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MACK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:865-637-6392
Mailing Address - Street 1:1940 ALCOA HWY
Mailing Address - Street 2:STE E-260
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-637-6392
Mailing Address - Fax:865-637-5216
Practice Address - Street 1:1940 ALCOA HWY
Practice Address - Street 2:STE E-260
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-637-6392
Practice Address - Fax:865-637-5216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3706174Medicaid
TN3706174Medicare ID - Type Unspecified