Organization Active NPI

Pediatric Consultants at Cedar Bluff

  • Pediatrics Physician
  • Knoxville, TN
National Provider Identifier
1316118714
Registry record updated Nov 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC CONSULTANTS AT CEDAR BLUFF
Practice address
9333 Park West Blvd Ste 104
Knoxville, TN 37923-4305
Phone
(865) 560-8778
Fax
(865) 394-6599
NPI assigned
Mar 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2017

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

Authorized official

Name
Tonya Owens
Title
Manager
Phone
(865) 560-8778

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X TN Primary

Addresses

Primary practice location

9333 Park West Blvd Ste 104
Knoxville, TN 37923-4305

Mailing address

Dept 888214
Knoxville, TN 37995-8214
Phone (865) 670-6199

Other identifiers 1

IdentifierTypeStateIssuer
Q013042MedicaidTN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D1077999Pediatric Consultants of Cedar Bluff Inc9333 Park West Blvd Ste 104, Knoxville, TN 37923Certificate of waiverDec 25, 2027

National Provider Directory

National Provider Directory

Locations

320 N Park 40 Blvd
Ste B
Knoxville, TN 37923
Phone (865) 690-6660

Dept 888214
Knoxville, TN 37995

9333 Park West Blvd
Ste 108A
Knoxville, TN 37923

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1205366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509494400000",
    "number": "1316118714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 888214",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379958214",
            "telephone_number": "865-670-6199",
            "fax_number": "865-670-6198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9333 PARK WEST BLVD STE 104",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234305",
            "telephone_number": "865-560-8778",
            "fax_number": "865-394-6599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CONSULTANTS AT CEDAR BLUFF",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-13",
        "last_updated": "2017-11-01",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "865-560-8778"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q013042",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.