Provider Demographics
NPI:1992839427
Name:STUART PC
Entity Type:Organization
Organization Name:STUART PC
Other - Org Name:DRS REID AND STANLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:865-329-4003
Mailing Address - Street 1:1932 ALCOA HWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1527
Mailing Address - Country:US
Mailing Address - Phone:865-329-4003
Mailing Address - Fax:865-329-4043
Practice Address - Street 1:1932 ALCOA HWY
Practice Address - Street 2:SUITE 280
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1527
Practice Address - Country:US
Practice Address - Phone:865-329-4003
Practice Address - Fax:865-329-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18992207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730119Medicare ID - Type UnspecifiedGROUP MEDICARE PROVIDER #