Basic Information
| Provider Information | |||||||||
| NPI: | 1770751216 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE UROLOGY ASSOCIATES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9724 KINGSTON PIKE | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379223347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656900602 | ||||||||
| FaxNumber: | 8656900515 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 OAK RIDGE TPKE | ||||||||
| Address2: | SUITE A101 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654831093 | ||||||||
| FaxNumber: | 8654828629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2008 | ||||||||
| LastUpdateDate: | 06/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | WALLACE | ||||||||
| AuthorizedOfficialFirstName: | RUTH | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 8656900602 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.