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NPI Code Detail

MEDICARE: ELIZABETH PORTER MSSW

MEDICARE: ELIZABETH PORTER MSSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1083006787
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH PORTER MSSW
Provider Business Mailing Address
First Line : 6350 W ANDREW JOHNSON HWY
Second Line : DEPARTMENT 100
City : TALBOTT
State : TN
Zip : 37877-8605
Country : US
Telephone Number : 800-355-3565
Fax Number : 423-714-2355
Provider Business Practice Location Address
First Line : 538 W 5TH AVE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37917-7109
Country : US
Telephone Number : 865-525-2104
Fax Number : 865-525-2212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2015
Last Update Date : 03/04/2015

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