=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659139434
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2024
-----------------------------------------------------
Last Update Date | 05/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2018 CLINCH AVE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37916-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-541-8491
-----------------------------------------------------
Fax | 865-541-8546
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2018 CLINCH AVE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37916-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-541-8491
-----------------------------------------------------
Fax | 865-541-8546
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF FINANCE/CFO
-----------------------------------------------------
Name | MS. CARYN HAWTHORNE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-541-8154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------