Basic Information
| Provider Information | |||||||||
| NPI: | 1164763751 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VOLUNTEER PSYCHIATRIC CONSULTANTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9040 EXECUTIVE PARK DR | ||||||||
| Address2: | SUITE 234 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379234640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655319129 | ||||||||
| FaxNumber: | 8888437657 | ||||||||
| Practice Location | |||||||||
| Address1: | 9040 EXECUTIVE PARK DR | ||||||||
| Address2: | SUITE 234 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379234640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655319129 | ||||||||
| FaxNumber: | 8888437657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2013 | ||||||||
| LastUpdateDate: | 03/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | MATHEWSON | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
| AuthorizedOfficialMiddleName: | ALBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8655319129 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | APN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 10492 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 3648105 | 01 | TN | MEDICARE TYPE UNSPECIFIED | OTHER |