Healthcare Provider Details

I. General information

NPI: 1922138262
Provider Name (Legal Business Name): INTERNAL MEDICINCE WEST A MEMBER OF COVENANT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 PARK WEST BLVD SUITE 402
KNOXVILLE TN
37923-4308
US

IV. Provider business mailing address

1400 CENTERPOINT BLVD SUITE 202
KNOXVILLE TN
37932-1979
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-3003
  • Fax: 865-690-6404
Mailing address:
  • Phone: 865-374-5200
  • Fax: 865-374-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MONTY SCOTT
Title or Position: PRESIDENT
Credential:
Phone: 865-374-5100