Basic Information
| Provider Information | |||||||||
| NPI: | 1194156992 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION INC. | ||||||||
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| OtherOrganizationName: | ETCH SLEEP MEDICINE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15004 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379015004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655418895 | ||||||||
| FaxNumber: | 8656334808 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 CHILDRENS WAY | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379227713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655464647 | ||||||||
| FaxNumber: | 8655461123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2013 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | HAWTHORNE | ||||||||
| AuthorizedOfficialFirstName: | CARYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO / VICE PRESIDENT FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 8655418181 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 2080S0012X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Sleep Medicine | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.