Healthcare Provider Details

I. General information

NPI: 1528029683
Provider Name (Legal Business Name): ATTENTUS OF SCOTT COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20445 ALBERTA ST
ONEIDA TN
37841-3509
US

IV. Provider business mailing address

PO BOX 4609
ONEIDA TN
37841-4609
US

V. Phone/Fax

Practice location:
  • Phone: 423-569-6396
  • Fax: 423-569-8640
Mailing address:
  • Phone: 423-569-7918
  • Fax: 423-569-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GARY M. CROSS
Title or Position: BOM
Credential:
Phone: 423-569-8521