Provider Demographics
NPI:1912966706
Name:MOEZ & SAIRA PREMJI INC
Entity Type:Organization
Organization Name:MOEZ & SAIRA PREMJI INC
Other - Org Name:LENOIR MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAIRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PREMJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-988-5774
Mailing Address - Street 1:308 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771
Mailing Address - Country:US
Mailing Address - Phone:865-988-5774
Mailing Address - Fax:
Practice Address - Street 1:308 E BDWY
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-3043
Practice Address - Country:US
Practice Address - Phone:865-988-5774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728138Medicaid
TN3728138Medicaid