1598014482 NPI number — COMPREHENSIVE HEALTHCARE SYSTEMS OF LENOIR CITY, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598014482 NPI number — COMPREHENSIVE HEALTHCARE SYSTEMS OF LENOIR CITY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE HEALTHCARE SYSTEMS OF LENOIR CITY, PC
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:
Provider Other Organization Name Type Code:
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:
1598014482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 S GALLAHER VIEW RD STE 224
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-951-2012
Provider Business Mailing Address Fax Number:
865-951-2575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 HIGHWAY 321 NORTH STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-816-6301
Provider Business Practice Location Address Fax Number:
865-816-6305
Provider Enumeration Date:
09/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HOFSTETTER
Authorized Official First Name:
SYLVIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE ADMINISTRATOR
Authorized Official Telephone Number:
865-321-3437

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X , with the licence number:  27951 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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