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General NPI Number Information
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NPI Number | 1366647455
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE CHILDREN'S HOSPITAL PRIMARY CARE CENTER, INC.
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 801 OAK RIDGE TURNPIKE
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City | OAK RIDGE
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State | TN
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Zip | 37830-6916
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Country | US
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Telephone | 865-482-4088
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Fax | 866-674-2033
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Provider Business Mailing Address
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Address Line | PO BOX 15004
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City | KNOXVILLE
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State | TN
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Zip | 37901-5004
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Country | US
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Telephone | 865-541-8895
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Fax | 865-633-4808
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Authorized Official
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Title or Position | VICE PRESIDENT FINANCE
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Name | CARYN HAWTHORNE
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Credential |
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Telephone | 865-541-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080S0010X
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Taxonomy Name | Pediatric Sports Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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