Healthcare Provider Details

I. General information

NPI: 1679988380
Provider Name (Legal Business Name): LUTHERAN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 DOMINICK PONT
KNOXVILLE TN
37934
US

IV. Provider business mailing address

305 DOMINICK PONT
KNOXVILLE TN
37934
US

V. Phone/Fax

Practice location:
  • Phone: 865-257-5359
  • Fax:
Mailing address:
  • Phone: 865-257-5359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. ANITA BROWN
Title or Position: DENTAL RESIDENT
Credential: D.D.S.,
Phone: 865-257-5359