Provider Demographics
NPI:1093016289
Name:EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.
Entity type:Organization
Organization Name:EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:865-675-8181
Mailing Address - Street 1:11227 WEST POINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934
Mailing Address - Country:US
Mailing Address - Phone:865-675-8181
Mailing Address - Fax:865-675-8111
Practice Address - Street 1:11227 W POINT DR
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-2838
Practice Address - Country:US
Practice Address - Phone:865-675-8181
Practice Address - Fax:865-675-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003162251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0447465Medicaid
TN447465Medicare PIN