MEDICARE: LTC PROVIDERS INCORPORATED

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	363LF0000X	Family Nurse Practitioner	APN 0000006533	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1912081381	OTHER	TN	INDIVIDUAL NPI
2	4133158	OTHER	TN	BCBC TN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861526956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LTC PROVIDERS INCORPORATED

Provider Business Mailing Address
First Line	:	428 E BURWELL AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-5007
Country	:	US
Telephone Number	:	865-546-1433
Fax Number	:

Provider Business Practice Location Address
First Line	:	428 E BURWELL AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-5007
Country	:	US
Telephone Number	:	865-546-1433
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DEBORAH ANNE THOMAS
Credential	:	NURSE PRACTIONER
Telephone Number	:	865-546-1433

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	08/22/2020

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Directions to “LTC PROVIDERS INCORPORATED ” Practice Location

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