Basic Information
Provider Information | |||||||||
NPI: | 1922095751 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FEINTUCH | ||||||||
FirstName: | THEODORE | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 51530 | ||||||||
Address2: |   | ||||||||
City: | KNOXVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 379501530 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8655882928 | ||||||||
FaxNumber: | 8654509374 | ||||||||
Practice Location | |||||||||
Address1: | 2333 MCCALLIE AVE | ||||||||
Address2: |   | ||||||||
City: | CHATTANOOGA | ||||||||
State: | TN | ||||||||
PostalCode: | 374043258 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4234931550 | ||||||||
FaxNumber: | 4236987858 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/06/2005 | ||||||||
LastUpdateDate: | 10/22/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | MD005138 | TN | Y |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | 029275 | GA | N |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
ID Information
ID | Type | State | Issuer | Description | 89063XE | 05 | NC |   | MEDICAID | TN0101 | 01 |   | JOHN DEERE HEALTH | OTHER | 3031326 | 01 |   | BC/BS OF TN | OTHER | PAYSUB | 01 |   | TRIGON | OTHER | 220020930 | 01 |   | RAILROAD MEDICARE | OTHER | 100011601 | 01 |   | PHP OF TN | OTHER | 1140003 | 01 |   | UNITED HEALTHCARE | OTHER | 264946 | 01 |   | BLACK LUNG | OTHER | 30403371 | 05 | TN |   | MEDICAID | 3383335 | 05 | TN |   | MEDICAID | 00544717A | 05 | GA |   | MEDICAID |