Provider Demographics
NPI:1588784938
Name:PRIME PROVIDER SYSTEMS, INC.
Entity type:Organization
Organization Name:PRIME PROVIDER SYSTEMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-584-4100
Mailing Address - Street 1:1111 N NORTHSHORE DR
Mailing Address - Street 2:SUITE SOUTH 450
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4005
Mailing Address - Country:US
Mailing Address - Phone:865-584-4100
Mailing Address - Fax:865-584-4100
Practice Address - Street 1:1111 N NORTHSHORE DR
Practice Address - Street 2:SUITE SOUTH 450
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4005
Practice Address - Country:US
Practice Address - Phone:865-584-4100
Practice Address - Fax:865-584-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)