Healthcare Provider Details

I. General information

NPI: 1265674550
Provider Name (Legal Business Name): SPECTRUM HEALTH ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 12/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 MINERAL SPRINGS AVE SUITE A
KNOXVILLE TN
37917-1569
US

IV. Provider business mailing address

2620 MINERAL SPRINGS AVE SUITE A
KNOXVILLE TN
37917-1570
US

V. Phone/Fax

Practice location:
  • Phone: 865-219-6968
  • Fax: 865-219-8636
Mailing address:
  • Phone: 865-219-6968
  • Fax: 865-219-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000020655
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000026566
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000027527
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN000006240
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000030531
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000039023
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD0000019665
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN0000077192
License Number StateTN
# 9
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000000518
License Number StateTN
# 10
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15673
License Number StateTN
# 11
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000027033
License Number StateTN

VIII. Authorized Official

Name: ERNEST E PICKETT
Title or Position: CEO
Credential:
Phone: 865-384-0007