Provider Demographics
NPI:1417095308
Name:FACULTY INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:FACULTY INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-288-1548
Mailing Address - Street 1:11440 PARKSIDE DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2658
Mailing Address - Country:US
Mailing Address - Phone:865-544-9740
Mailing Address - Fax:865-377-1002
Practice Address - Street 1:11440 PARKSIDE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2658
Practice Address - Country:US
Practice Address - Phone:865-218-9220
Practice Address - Fax:865-218-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3623639Medicaid
TN3723629Medicare ID - Type UnspecifiedGROUP MEDCIARE NUMBER