Healthcare Provider Details

I. General information

NPI: 1568691822
Provider Name (Legal Business Name): ECC WEST TENNESSEE MC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 CENTERPOINT BLVD SUITE 100
KNOXVILLE TN
37932-1984
US

IV. Provider business mailing address

1900 N WINSTON RD SUITE 300
KNOXVILLE TN
37919-3606
US

V. Phone/Fax

Practice location:
  • Phone: 888-203-1274
  • Fax:
Mailing address:
  • Phone: 888-203-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN R STALEY JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 888-203-1274