Provider Demographics
NPI:1417461211
Name:LEAN KNOX, LLC
Entity Type:Organization
Organization Name:LEAN KNOX, LLC
Other - Org Name:MEDI WEIGHTLOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JORDYN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MINAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-474-1490
Mailing Address - Street 1:317 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5310
Mailing Address - Country:US
Mailing Address - Phone:865-474-1490
Mailing Address - Fax:865-249-8298
Practice Address - Street 1:317 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5310
Practice Address - Country:US
Practice Address - Phone:865-474-1490
Practice Address - Fax:865-249-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty