Provider Demographics
NPI:1174536072
Name:KNOXVILLE HEART CENTER PC
Entity type:Organization
Organization Name:KNOXVILLE HEART CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MISTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-986-8121
Mailing Address - Street 1:689 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5642
Mailing Address - Country:US
Mailing Address - Phone:865-986-8121
Mailing Address - Fax:865-986-8124
Practice Address - Street 1:689 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5642
Practice Address - Country:US
Practice Address - Phone:865-986-8121
Practice Address - Fax:865-986-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD27232207R00000X
207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E44398Medicare UPIN
TN3709153Medicare ID - Type Unspecified