| NPI | 1871810093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON MARTIN Owner 865-776-8761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN 3409) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: TN 3409) |
| 302R00000X Health Maintenance Organization (Licence: TN 3409) | |
| 305S00000X Point of Service (Licence: TN 3409) | |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2010-04-27 |