Kevin D Barna, CPO
Individual provider Active NPI Specialist · Cleveland, TN
NPI 1174701072 · NPPES record last updated Feb 4, 2008
Key facts
- NPI
- 1174701072
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 45PO00010800 (NJ)
- Practice address
- 2150 N Ocoee St Ste 2
Cleveland, TN 37311-3937 - Phone
- (423) 559-0013
- Fax
- (423) 559-2442
- NPI assigned
- Feb 4, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45PO00010800 | NJ | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Custom Healthcare, LLC | Past | Accepting new patients | |
| Custom Healthcare, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 45PO00010800 | NJ | Yes |
Addresses
Primary practice location
2150 N Ocoee St Ste 2
Cleveland, TN 37311-3937
Mailing address
3700 Brainerd Rd
Chattanooga, TN 37411-3603
Phone (423) 697-0057
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1455062 | Medicaid | TN |
Other providers in Cleveland, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.