1023150380 NPI number — SEVIER COUNTY HEALTH CARE CENTER, INC.

Table of content: (NPI 1023150380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023150380 NPI number — SEVIER COUNTY HEALTH CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEVIER COUNTY HEALTH CARE CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SEVIER COUNTY HEALTH CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023150380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 CATLETT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEVIERVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37862-5901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-453-4747
Provider Business Mailing Address Fax Number:
865-453-7148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 CATLETT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEVIERVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37862-5901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-453-4747
Provider Business Practice Location Address Fax Number:
865-453-7148
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ATCHLEY
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
865-453-4747

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  229 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 229 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0009732 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0445132 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7440314 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 445132 . This is a "CARITEN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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