Healthcare Provider Details

I. General information

NPI: 1982929279
Provider Name (Legal Business Name): PEDIATRIC CONSULTANTS WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HUXLEY RD
KNOXVILLE TN
37922-3197
US

IV. Provider business mailing address

PO BOX 440215
NASHVILLE TN
37244-0215
US

V. Phone/Fax

Practice location:
  • Phone: 865-691-3335
  • Fax: 865-691-3310
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DENISE DEROSSETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 865-691-3335