Healthcare Provider Details

I. General information

NPI: 1528622321
Provider Name (Legal Business Name): PREMIER-COVENANT ASTC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 PAPERMILL DR
KNOXVILLE TN
37919-4858
US

IV. Provider business mailing address

6408 PAPERMILL DR STE 220
KNOXVILLE TN
37919-4858
US

V. Phone/Fax

Practice location:
  • Phone: 865-306-5701
  • Fax: 865-584-7712
Mailing address:
  • Phone: 865-306-5701
  • Fax: 865-584-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAY ROM
Title or Position: CEO
Credential:
Phone: 865-306-5701