Provider Demographics
NPI:1659403590
Name:ADVANTAGE FAMILY HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:ADVANTAGE FAMILY HEALTHCARE, PLLC
Other - Org Name:CAMPBELL STATION PRIMARY CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC, RN, MT
Authorized Official - Phone:865-675-7522
Mailing Address - Street 1:11541 KINGSTON PIKE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-3918
Mailing Address - Country:US
Mailing Address - Phone:865-675-7522
Mailing Address - Fax:865-671-3196
Practice Address - Street 1:11541 KINGSTON PIKE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3918
Practice Address - Country:US
Practice Address - Phone:865-675-7522
Practice Address - Fax:865-671-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728422Medicaid
TN4029196OtherBCBST GROUP
TNTN103OtherUNITED HEALTH RIVER VALL
TN100034888OtherPHP CARITEN ID NUMBER
TN190646OtherUNITED HEALTHCARE GROUP #
TN7768236OtherAETNA US HEALTHCARE ID
TN4050284OtherBLUECROSS BLUESHIELD OF T
TN4050284OtherBLUECROSS BLUESHIELD OF T
TN=========OtherUNITED HEALTHCARE NUMBER
TN3728422Medicaid