Healthcare Provider Details

I. General information

NPI: 1265589964
Provider Name (Legal Business Name): KNOXVILLE-KNOX COUNTY COMMUNITY ACTION COMMITTEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2247 WESTERN AVE
KNOXVILLE TN
37921-5756
US

IV. Provider business mailing address

PO BOX 51650
KNOXVILLE TN
37950-1650
US

V. Phone/Fax

Practice location:
  • Phone: 865-524-0319
  • Fax: 865-546-9013
Mailing address:
  • Phone: 865-524-0319
  • Fax: 865-546-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: BARBARA KELLY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 865-546-3500