Basic Information
| Provider Information | |||||||||
| NPI: | 1407997711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FARRAGUT FAMILY CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 N CAMPBELL STATION RD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379342753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656751953 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 N CAMPBELL STATION RD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379342753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656751953 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 05/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | ELLIS | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRIVACY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8655492121 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEALTH VENTURES | ||||||||
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| AuthorizedOfficialCredential: | RHIT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.