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General NPI Number Information
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NPI Number | 1821492158
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE URGENT CARE
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 311 S WEISGARBER RD
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City | KNOXVILLE
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State | TN
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Zip | 37919-7504
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Country | US
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Telephone | 865-577-3882
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Fax | 865-577-3889
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Provider Business Mailing Address
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Address Line | PO BOX 11484
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City | KNOXVILLE
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State | TN
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Zip | 37939-1484
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Country | US
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Telephone | 865-577-3882
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Fax | 865-577-3889
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. TONYA TUTOR
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Credential |
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Telephone | 865-577-3882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 020952
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License Number State | TN
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