Provider Demographics
NPI:1093930646
Name:KNOX MEDICAL SPECIALISTS, INC
Entity Type:Organization
Organization Name:KNOX MEDICAL SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-397-8500
Mailing Address - Street 1:1451 YAUGER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050
Mailing Address - Country:US
Mailing Address - Phone:740-397-8500
Mailing Address - Fax:740-397-8527
Practice Address - Street 1:1451 YAUGER RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-397-8500
Practice Address - Fax:740-397-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0351828Medicaid
OH1639250830OtherINDIVIDUAL NPI
OH0306467Medicaid
OH1972684173OtherINDIVIDUAL NPI
OHA75589Medicare UPIN
OH1639250830OtherINDIVIDUAL NPI
OHG27121Medicare UPIN
OH0422331Medicare ID - Type Unspecified