Provider Demographics
NPI:1043462401
Name:KENT H. VAN ARSDELL, M.D.
Entity type:Organization
Organization Name:KENT H. VAN ARSDELL, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:VAN ARSDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-693-9373
Mailing Address - Street 1:9217 PARK WEST BLVD
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4404
Mailing Address - Country:US
Mailing Address - Phone:865-693-9373
Mailing Address - Fax:865-693-5368
Practice Address - Street 1:9217 PARK WEST BLVD
Practice Address - Street 2:SUITE C-3
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4404
Practice Address - Country:US
Practice Address - Phone:865-693-9373
Practice Address - Fax:865-693-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD025081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3057214Medicaid
TN3057214Medicaid