Healthcare Provider Details

I. General information

NPI: 1528098282
Provider Name (Legal Business Name): EAST TENNESSEE PULMONARY AND CRITICAL CARE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E BLOUNT AVE SUITE 200
KNOXVILLE TN
37920-1618
US

IV. Provider business mailing address

200 E BLOUNT AVE SUITE 200
KNOXVILLE TN
37920-1618
US

V. Phone/Fax

Practice location:
  • Phone: 865-549-4413
  • Fax: 865-549-4414
Mailing address:
  • Phone: 865-549-4413
  • Fax: 865-549-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA POWERS
Title or Position: MANAGER
Credential:
Phone: 865-207-6793