MEDICARE: HEARTLAND INFUSION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QI0500X	Infusion Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0575	OTHER	TN	LOCAL PART B
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174007538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND INFUSION

Provider Business Mailing Address
First Line	:	9943 KINGSTON PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6923
Country	:	US
Telephone Number	:	865-862-4557
Fax Number	:

Provider Business Practice Location Address
First Line	:	9943 KINGSTON PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6923
Country	:	US
Telephone Number	:	865-862-4557
Fax Number	:	865-862-4556

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES RAY WALL
Credential	:
Telephone Number	:	865-689-9778

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	03/02/2021

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Directions to “HEARTLAND INFUSION ” Practice Location

Language	Start Address	Practice Location

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