Healthcare Provider Details

I. General information

NPI: 1801664594
Provider Name (Legal Business Name): ERLANGER HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 HOLIDAY INN EXPRESS WAY NW STE 104
CLEVELAND TN
37312-1469
US

IV. Provider business mailing address

4312 HOLIDAY INN EXPRESS WAY NW STE 104
CLEVELAND TN
37312-1469
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MIKE DALE SHAVER
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 423-778-4712