Healthcare Provider Details

I. General information

NPI: 1215101829
Provider Name (Legal Business Name): BAPTIST PRIMARY AND SENIOR CARE-CHERRY STREET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N CHERRY ST
KNOXVILLE TN
37914-5254
US

IV. Provider business mailing address

PO BOX 23740
KNOXVILLE TN
37933-1740
US

V. Phone/Fax

Practice location:
  • Phone: 865-523-8987
  • Fax:
Mailing address:
  • Phone: 865-549-4342
  • Fax: 865-549-4341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSANNE NELMS
Title or Position: DIRECTOR
Credential:
Phone: 865-549-4892