| Organization Name: | FORT SANDERS KIDNEY CENTER |
| NPI Number: | 1821022740 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NASEEMUL SIDDIQI (MEDICAL DOCTOR) |
| Mailing Address: | 503 Elm Ave New Tazewell |
| State: | TN US |
| Postal Code: | 378257525 |
| Phone Number: | 8656375186 |
| Fax Number: | 8656375121 |
| NPI Enumeration Date: | 07/10/2006 |
| NPI Last Update Date: | 10/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | 0000000002 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |