Healthcare Provider Details

I. General information

NPI: 1588094494
Provider Name (Legal Business Name): EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CLINCH AVE STE 410
KNOXVILLE TN
37916-2287
US

IV. Provider business mailing address

PO BOX 50068
KNOXVILLE TN
37950-0068
US

V. Phone/Fax

Practice location:
  • Phone: 865-343-6976
  • Fax: 877-554-2891
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 Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREW ROSENDAHL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 865-541-8154