Forked Deer River Inpatient Services, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FORKED DEER RIVER INPATIENT SERVICES, PLLC

Practice address

400 E Tickle St
Dyersburg, TN 38024-3120

Phone

(731) 285-2410

Fax

(800) 305-3233

NPI assigned

Sep 17, 2013

Organization subpart

No

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

Authorized official

Name

Kathy Kondas

Title

Officer

Phone

(973) 251-1132

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1379376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608508800000",
    "number": "1750717195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 S PALAFOX ST",
            "address_2": "3RD FLOOR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325025960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E TICKLE ST",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243120",
            "telephone_number": "731-285-2410",
            "fax_number": "800-305-3233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORKED DEER RIVER INPATIENT SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-17",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A",
        "authorized_official_last_name": "KONDAS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "973-251-1132"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Dyersburg, TN
• Providers in Dyersburg, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; 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.