Provider Demographics
NPI:1285635680
Name:MEDICAL SPECIALISTS OF KNOXVILLE, PLLC
Entity Type:Organization
Organization Name:MEDICAL SPECIALISTS OF KNOXVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-688-1584
Mailing Address - Street 1:9111 CROSS PARK DR STE D200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4521
Mailing Address - Country:US
Mailing Address - Phone:865-688-1584
Mailing Address - Fax:865-688-1581
Practice Address - Street 1:9111 CROSS PARK DR STE D200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4521
Practice Address - Country:US
Practice Address - Phone:865-688-1584
Practice Address - Fax:865-688-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
TN=========207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1285635680Medicaid
TN3374571Medicaid
TNCK2067Medicare ID - Type UnspecifiedRAILROAD