Basic Information
| Provider Information | |||||||||
| NPI: | 1639102676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY REHABILITATION ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 888230 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379958230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656706199 | ||||||||
| FaxNumber: | 8656706188 | ||||||||
| Practice Location | |||||||||
| Address1: | 1932 ALCOA HWY | ||||||||
| Address2: | SUITE 580 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653056333 | ||||||||
| FaxNumber: | 8653056364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 03/31/2010 | ||||||||
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| AuthorizedOfficialLastName: | HECHT | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8653056333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 3715819 | 05 | TN | MEDICAID |