Provider Demographics
NPI:1407099716
Name:KLINNER ENTERPRISES
Entity Type:Organization
Organization Name:KLINNER ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KLINNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-238-4700
Mailing Address - Street 1:9203 LEE HWY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6458
Mailing Address - Country:US
Mailing Address - Phone:423-238-4700
Mailing Address - Fax:423-238-4747
Practice Address - Street 1:9203 LEE HWY
Practice Address - Street 2:SUITE 9
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6458
Practice Address - Country:US
Practice Address - Phone:423-238-4700
Practice Address - Fax:423-238-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD19093207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103351Medicaid
TN30449111Medicare PIN
TNC72482Medicare UPIN