Basic Information
| Provider Information | |||||||||
| NPI: | 1124020011 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KROLL | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 SAUNDERSVILLE ROAD | ||||||||
| Address2: | 160 | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158243737 | ||||||||
| FaxNumber: | 8555404722 | ||||||||
| Practice Location | |||||||||
| Address1: | 353 NEW SHACKLE ISLAND RD | ||||||||
| Address2: | SUITE 122B | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370752379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158243737 | ||||||||
| FaxNumber: | 8555404722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 07/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | MD0000036963 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 36963 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD36963 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | MD36963 | TN | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00450337 | 01 | TN | RAILROAD MEDICARE | OTHER | 7502422 | 01 | TN | AETNA | OTHER | 3377000 | 05 | TN | MEDICAID | 10069948 | 01 | TN | AMERIGROUP | OTHER | 3878748 | 05 | TN | MEDICAID | 4129006 | 01 | TN | BCBS | OTHER |