Basic Information
| Provider Information | |||||||||
| NPI: | 1841369402 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EHRENFRIED | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ALBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 CLINCHFIELD STREET, | ||||||||
| Address2: | SUITE 2900 | ||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232456101 | ||||||||
| FaxNumber: | 4232452396 | ||||||||
| Practice Location | |||||||||
| Address1: | 444 CLINCHFIELD STREET | ||||||||
| Address2: | SUITE 2900 | ||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232456101 | ||||||||
| FaxNumber: | 4232452396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 03/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD34462 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3151526 | 01 | TN | BLUE CROSS TENNESSEE | OTHER | 382329 | 01 | VA | ANTHEM VIRGINIA BCBS | OTHER | 910000313 | 01 | TN | MEDICARE RAILROAD | OTHER | 007311095 | 05 | VA | MEDICAID | 3046047 | 05 | TN | MEDICAID |