Provider Demographics
NPI:1063073286
Name:EAST TOWN HEALTH AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:EAST TOWN HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-522-6300
Mailing Address - Street 1:4800 MILLERTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-2138
Mailing Address - Country:US
Mailing Address - Phone:865-522-6300
Mailing Address - Fax:865-522-2455
Practice Address - Street 1:4800 MILLERTOWN PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-2138
Practice Address - Country:US
Practice Address - Phone:865-522-6300
Practice Address - Fax:865-522-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service