Provider Demographics
NPI:1790708030
Name:KAMILIA F KOZLOWSKI
Entity Type:Organization
Organization Name:KAMILIA F KOZLOWSKI
Other - Org Name:KNOXVILLE COMPREHENSIVE BREAST CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-584-0291
Mailing Address - Street 1:1400 DOWELL SPRINGS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2456
Mailing Address - Country:US
Mailing Address - Phone:865-584-0291
Mailing Address - Fax:865-584-4426
Practice Address - Street 1:1400 DOWELL SPRINGS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2456
Practice Address - Country:US
Practice Address - Phone:865-584-0291
Practice Address - Fax:865-584-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3721933Medicare ID - Type Unspecified
6400450001Medicare NSC