Provider Demographics
NPI:1790729515
Name:KNOXVILLE MEDICAL AND INDUSTRIAL CLINIC
Entity Type:Organization
Organization Name:KNOXVILLE MEDICAL AND INDUSTRIAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-522-2168
Mailing Address - Street 1:4306 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-3601
Mailing Address - Country:US
Mailing Address - Phone:865-522-2168
Mailing Address - Fax:865-522-7116
Practice Address - Street 1:4306 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-3601
Practice Address - Country:US
Practice Address - Phone:865-522-2168
Practice Address - Fax:865-522-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCB6822OtherRAILROAD MEDICARE
TNCB6822OtherRAILROAD MEDICARE