Healthcare Provider Details

I. General information

NPI: 1477941375
Provider Name (Legal Business Name): EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 CLINCH AVENUE SOUTH TOWER 2ND FLOOR
KNOXVILLE TN
37916-2301
US

IV. Provider business mailing address

PO BOX 50068
KNOXVILLE TN
37950-0068
US

V. Phone/Fax

Practice location:
  • Phone: 865-525-1425
  • Fax: 877-935-4221
Mailing address:
  • Phone: 865-541-8895
  • Fax: 865-633-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREW ROSENDAHL
Title or Position: CFO
Credential:
Phone: 612-237-4353