Provider Demographics
NPI:1942352992
Name:FORT SANDERS NEUROSURGICAL CLINIC
Entity Type:Organization
Organization Name:FORT SANDERS NEUROSURGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NATELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-525-2601
Mailing Address - Street 1:2001 LAUREL AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1810
Mailing Address - Country:US
Mailing Address - Phone:865-525-2601
Mailing Address - Fax:865-544-3802
Practice Address - Street 1:2001 LAUREL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1810
Practice Address - Country:US
Practice Address - Phone:865-525-2601
Practice Address - Fax:865-544-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD7615174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2005526OtherBCBS
TN3382950Medicaid
TN3382950Medicare ID - Type Unspecified
TN3382950Medicaid