Provider Demographics
NPI:1497924666
Name:COLON & RECTAL SURGERY OF KNOXVILLE
Entity Type:Organization
Organization Name:COLON & RECTAL SURGERY OF KNOXVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-305-9248
Mailing Address - Street 1:PO BOX 888200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-8200
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6158
Practice Address - Street 1:1930 ALCOA HWY
Practice Address - Street 2:STE 240
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1500
Practice Address - Country:US
Practice Address - Phone:865-305-9248
Practice Address - Fax:865-525-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 24234208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3074785Medicaid
TN3074785Medicare PIN
TN3074785Medicaid