Provider Demographics
NPI:1114912433
Name:NEPHROLOGY ASSOCIATES OF KNOXVILLE, PC
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES OF KNOXVILLE, PC
Other - Org Name:UNIVERSITY NEPHROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:865-546-9246
Mailing Address - Street 1:1932 ALCOA HWY
Mailing Address - Street 2:STE C460
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-546-9246
Mailing Address - Fax:865-523-6466
Practice Address - Street 1:1932 ALCOA HWY
Practice Address - Street 2:STE C460
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-546-9246
Practice Address - Fax:865-523-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723987Medicaid
TN3723987Medicaid