Healthcare Provider Details

I. General information

NPI: 1679525448
Provider Name (Legal Business Name): EAST TENNESSEE CARDIOVASCULAR SURGERY GROUP, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9125 CROSS PARK DRIVE SUITE 200
KNOXVILLE TN
37923-4505
US

IV. Provider business mailing address

9125 CROSS PARK DRIVE SUITE 200
KNOXVILLE TN
37923-4505
US

V. Phone/Fax

Practice location:
  • Phone: 865-632-5900
  • Fax: 865-637-2114
Mailing address:
  • Phone: 865-632-5900
  • Fax: 865-637-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateTN

VIII. Authorized Official

Name: MR. ROBERT CRAIG BRENT
Title or Position: CAO
Credential:
Phone: 865-632-5900