Provider Demographics
NPI:1427283787
Name:BAPTIST PRIMARY & SENIOR HEALTHCARE CENTER BROADWAY
Entity type:Organization
Organization Name:BAPTIST PRIMARY & SENIOR HEALTHCARE CENTER BROADWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-549-4892
Mailing Address - Street 1:939 EMERALD AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4502
Mailing Address - Country:US
Mailing Address - Phone:865-522-8922
Mailing Address - Fax:865-521-7293
Practice Address - Street 1:939 EMERALD AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4502
Practice Address - Country:US
Practice Address - Phone:865-522-8922
Practice Address - Fax:865-521-7293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY PHYSICIAN SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-15
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373630Medicare Oscar/Certification