=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477849172
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART RHYTHM SPECIALISTS OF EAST TENNESSEE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2011
-----------------------------------------------------
Last Update Date | 06/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 921 W 4TH NORTH ST
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814-3814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-694-2775
-----------------------------------------------------
Fax | 865-694-2725
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9314 PARKWEST BLVD
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37923-9314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-694-2775
-----------------------------------------------------
Fax | 865-694-2725
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. ANGELA HALCOMB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-694-2775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------