Basic Information
Provider Information | |||||||||
NPI: | 1972570661 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BEELER | ||||||||
FirstName: | THOMAS | ||||||||
MiddleName: | CRAIG | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 260 FORT SANDERS WEST BLVD | ||||||||
Address2: |   | ||||||||
City: | KNOXVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 379223355 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8655584400 | ||||||||
FaxNumber: | 8655584471 | ||||||||
Practice Location | |||||||||
Address1: | 1422 OLD WEISGARBER RD | ||||||||
Address2: |   | ||||||||
City: | KNOXVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 379091293 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8655584400 | ||||||||
FaxNumber: | 8655584471 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/02/2006 | ||||||||
LastUpdateDate: | 05/15/2014 | ||||||||
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 | 207X00000X | MD9389 | TN | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207XX0005X | 9389 | TN | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
ID | Type | State | Issuer | Description | 200029913 | 01 | TN | RAILROAD MEDICARE | OTHER | 3071380 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | TN0145 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | 1195343 | 01 | TN | UNITED HEALTH CARE | OTHER | 3184271 | 05 | TN |   | MEDICAID | 100011151 | 01 | TN | TENNCARE | OTHER | TN0130 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | 4457979 | 01 | TN | AETNA | OTHER |