| East Tenn Neurology Cl Pc | |
|
9430 Parkwest Blvd Suite 350 Knoxville TN 37923-4203 | |
| (865) 531-9430 | |
| (865) 531-9580 |
| Full Name | East Tenn Neurology Cl Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 9430 Parkwest Blvd, Knoxville, Tennessee |
| Authorized Official Name and Position | Sam Al-kabbani (PRESIDENT) |
| Authorized Official Contact | 8655319430 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Tenn Neurology Cl Pc 9430 Parkwest Blvd Suite 350 Knoxville TN 37923 Ph: (865) 531-9430 | East Tenn Neurology Cl Pc 9430 Parkwest Blvd Suite 350 Knoxville TN 37923-4203 Ph: (865) 531-9430 |
| NPI Number | 1932308293 |
|---|---|
| Provider Enumeration Date | 07/16/2007 |
| Last Update Date | 07/19/2007 |
| Medicare PECOS PAC ID | 7810011194 |
|---|---|
| Medicare Enrollment ID | O20100824001027 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932308293 | NPI | - | NPPES |
| 3386763 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | MD17875 (Tennessee) | Primary |
| Provider Name | Samir Al-kabbani |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1083681183 PECOS PAC ID: 5698664167 Enrollment ID: I20040312000543 |
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