Provider Demographics
NPI:1336340108
Name:STEVEN R KINNEY, MD
Entity Type:Organization
Organization Name:STEVEN R KINNEY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FLO
Authorized Official - Middle Name:STALLWORTH
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-874-9888
Mailing Address - Street 1:244 JACKSON MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1425
Mailing Address - Country:US
Mailing Address - Phone:615-874-9888
Mailing Address - Fax:615-883-6899
Practice Address - Street 1:244 JACKSON MEADOWS DR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1425
Practice Address - Country:US
Practice Address - Phone:615-874-9888
Practice Address - Fax:615-883-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN012856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3714993Medicare PIN
TNB04392Medicare UPIN