Healthcare Provider Details

I. General information

NPI: 1255702635
Provider Name (Legal Business Name): COMMUNITY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N CEDAR BLUFF RD
KNOXVILLE TN
37923-2805
US

IV. Provider business mailing address

507 N CEDAR BLUFF RD
KNOXVILLE TN
37923-2805
US

V. Phone/Fax

Practice location:
  • Phone: 865-769-5388
  • Fax:
Mailing address:
  • Phone: 865-769-5388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number477865974
License Number StateTN

VIII. Authorized Official

Name: DR. RILEY SENTER
Title or Position: OWNER
Credential:
Phone: 865-934-2655