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General NPI Number Information
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NPI Number | 1467538009
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Entity Type | Organization
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Legal Business Name | STATE OF TENNESSEE
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 5908 LYONS VIEW PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37919
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Country | US
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Telephone | 865-584-1561
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Fax | 865-450-5203
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Provider Business Mailing Address
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Address Line | 5908 LYONS VIEW PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37919
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Country | US
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Telephone | 865-584-1561
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Fax | 865-450-5203
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER - CEO
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Name | MR. RICHARD L THOMAS
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Credential |
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Telephone | 865-583-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | L2161051102
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License Number State | TN
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