| NPI | 1487075099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT HARLEY ODELL Secretary 865-673-5000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X (Licence: TN 00000206) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 332900000X Non-Pharmacy Dispensing Site (Licence: TN 4447050) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 7068360001) | |
| Enumeration Date | 2013-12-27 |
| Last Update Date | 2025-02-17 |