Healthcare Provider Details

I. General information

NPI: 1033866769
Provider Name (Legal Business Name): EAST TENNESSEE MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 ANDREW JOHNSON HWY
STRAWBERRY PLAINS TN
37871-1015
US

IV. Provider business mailing address

524 ANDREW JOHNSON HWY
STRAWBERRY PLAINS TN
37871-1015
US

V. Phone/Fax

Practice location:
  • Phone: 865-933-4149
  • Fax: 865-933-4037
Mailing address:
  • Phone: 865-933-4149
  • Fax: 865-933-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHASE ARMS
Title or Position: AUTHORIZED OFFICIAL / MANAGER
Credential: PHARM D
Phone: 865-603-2782