1235350901 NPI number — EAST TENNESSEE CHILDREN'S HOSPITAL PRIMARY CARE CENTER, INC.

Table of content: (NPI 1235350901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235350901 NPI number — EAST TENNESSEE CHILDREN'S HOSPITAL PRIMARY CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST TENNESSEE CHILDREN'S HOSPITAL PRIMARY 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:
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:
1235350901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 15004
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:
37901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-541-8895
Provider Business Mailing Address Fax Number:
865-633-4808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2018 CLINCH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-541-8000
Provider Business Practice Location Address Fax Number:
865-633-4808
Provider Enumeration Date:
05/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAWTHORNE
Authorized Official First Name:
CARYN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT FINANCE
Authorized Official Telephone Number:
865-541-8181

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM2500X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: Q038603 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".