Healthcare Provider Details

I. General information

NPI: 1487190443
Provider Name (Legal Business Name): THCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 SPACE PARK S
NASHVILLE TN
37211-3123
US

IV. Provider business mailing address

9051 EXECUTIVE PARK DR
KNOXVILLE TN
37923-4606
US

V. Phone/Fax

Practice location:
  • Phone: 701-500-5799
  • Fax:
Mailing address:
  • Phone: 701-500-5799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number177803
License Number StateTN

VIII. Authorized Official

Name: POLLYANN GRUBELNIK
Title or Position: MANAGER
Credential:
Phone: 701-500-5799