Provider Demographics
NPI:1942698345
Name:COMMONWEALTH MEDICAL CORP
Entity Type:Organization
Organization Name:COMMONWEALTH MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INFRASTRUCTURE AND DESIGN CONCEPTS
Authorized Official - Prefix:
Authorized Official - First Name:THEO
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-936-5635
Mailing Address - Street 1:5210 S MIDDLEBROOK PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-5972
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2427 PINEY GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-3765
Practice Address - Country:US
Practice Address - Phone:865-936-5635
Practice Address - Fax:865-622-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty