Provider Demographics
NPI:1336148816
Name:JENIFER KURTZ MD PC
Entity Type:Organization
Organization Name:JENIFER KURTZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ALCORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-573-4794
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-0391
Mailing Address - Country:US
Mailing Address - Phone:865-573-4794
Mailing Address - Fax:865-573-4794
Practice Address - Street 1:3608 BLUFF POINT DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2806
Practice Address - Country:US
Practice Address - Phone:865-573-4794
Practice Address - Fax:865-573-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000031607313M00000X, 314000000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3841499Medicaid
TN3841499Medicaid