Basic Information
Provider Information
NPI: 1720007941
EntityType: 2
ReplacementNPI:  
OrganizationName: REGIONAL TRAUMA SURGEONS
LastName:  
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Credential:  
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Mailing Information
Address1: PO BOX 440268
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372440268
CountryCode: US
TelephoneNumber: 8656706199
FaxNumber: 8656706158
Practice Location
Address1: 1932 ALCOA HWY STE 270
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379201537
CountryCode: US
TelephoneNumber: 8655449433
FaxNumber: 8655448688
Other Information
ProviderEnumerationDate: 07/19/2006
LastUpdateDate: 04/09/2012
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: PLUMMER
AuthorizedOfficialFirstName: ADRIANNA
AuthorizedOfficialMiddleName: D.
AuthorizedOfficialTitleorPosition: BILLING SUPERVISOR
AuthorizedOfficialTelephone: 8652514658
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2086S0127X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery

ID Information
IDTypeStateIssuerDescription
373470205TN MEDICAID


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