1497992309 NPI number — CHEROKEE HEALTH SYSTEMS

Table of content: (NPI 1497992309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497992309 NPI number — CHEROKEE HEALTH SYSTEMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEROKEE HEALTH SYSTEMS
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:
1497992309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6350 W A J HWY
Provider Second Line Business Mailing Address:
DEPARTMENT 100
Provider Business Mailing Address City Name:
TALBOTT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-355-3565
Provider Business Mailing Address Fax Number:
423-714-2355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 ADESA BLVD
Provider Second Line Business Practice Location Address:
STE A-150
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37771-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-986-8082
Provider Business Practice Location Address Fax Number:
865-986-5890
Provider Enumeration Date:
01/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
423-587-7337

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 44-1880 . This is a "FQHC - MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3686393 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3696394 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3706725 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44-1880 . This is a "FQHC - MEDICAID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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