Provider Demographics
NPI:1023092426
Name:MPS-CARDIOLOGY LLC
Entity type:Organization
Organization Name:MPS-CARDIOLOGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-525-6688
Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-602-6700
Mailing Address - Fax:865-602-6801
Practice Address - Street 1:1225 E WEISGARBER RD
Practice Address - Street 2:SUITE 190
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2604
Practice Address - Country:US
Practice Address - Phone:865-602-6700
Practice Address - Fax:865-602-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65917767Medicaid
NC890191KMedicaid
KY7100120510Medicaid
TN3380219Medicaid
TN1519407Medicaid
OH0373251Medicaid
FL905861300Medicaid
DQ3925Medicare PIN
CA3049Medicare PIN
OH0373251Medicaid
FL905861300Medicaid
TN1519407Medicaid
TN3380219Medicare PIN