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General NPI Number Information
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NPI Number | 1619876992
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE CHILDREN'S PRIMARY CARE CENTER, INC.
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 4005 FOUNTAIN VALLEY DR STE 150
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City | KNOXVILLE
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State | TN
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Zip | 37918-5334
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Country | US
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Telephone | 865-223-6561
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Fax | 865-377-1035
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Provider Business Mailing Address
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Address Line | PO BOX 50068
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City | KNOXVILLE
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State | TN
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Zip | 37950-0068
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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 | CFO
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Name | ANDREW ROSENDAHL
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Credential |
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Telephone | 865-541-8154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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