Petre-Jo LLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

L000000017166 Issued in TN

Legal business name

PETRE-JO LLC

Practice address

607 W Due West Ave Ste 95
Madison, TN 37115-4415

Phone

(615) 982-8081

NPI assigned

Apr 6, 2016

Organization subpart

Yes

Parent organization

PETRE-JO LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Peter Konecny

Title

Managing Member

Phone

(931) 761-0410

Specialties & licenses 1

Addresses

Part of

Petre-Jo LLC

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459900800000",
    "number": "1063876076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "858 HARBOUR GREENS PL",
            "city": "SPARTA",
            "state": "TN",
            "postal_code": "385834294",
            "telephone_number": "931-761-0410",
            "fax_number": "855-210-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 W DUE WEST AVE STE 95",
            "city": "MADISON",
            "state": "TN",
            "postal_code": "371154415",
            "telephone_number": "615-982-8081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRE-JO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PETRE-JO LLC",
        "enumeration_date": "2016-04-06",
        "last_updated": "2016-04-06",
        "status": "A",
        "authorized_official_last_name": "KONECNY",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "931-761-0410"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "TN",
            "license": "L000000017166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harold Clay Peeples, DDS
• Vera Susan Pendergraft, BS
• Anthony Vincent Perry, O.D.
• Joseph Peters II, DMD
• Eric Petersen, FNP-C
• Joshua Petrunger, PHARMD
• Tristan K Petty, LPC/MHSP
• Keller F. Phalen, CRNA
• Tu T Pham
• Vivian Pham

• Preferred Provider Organization in Madison, TN
• Providers in Madison, TN by specialty
• Preferred Provider Organization in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.