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General NPI Number Information
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NPI Number | 1679126056
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION INC.
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 1817 W MORRIS BLVD
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City | MORRISTOWN
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State | TN
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Zip | 37813-2837
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Country | US
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Telephone | 865-522-0420
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Fax | 877-801-6771
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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 | PRACTICE ADMINISTRATOR
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Name | MARK B MASON
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Credential |
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Telephone | 865-541-8053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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