Provider Demographics
NPI:1992886899
Name:EAST TENNESSEE COLON & RECTAL SURGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:EAST TENNESSEE COLON & RECTAL SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHASTEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-392-9220
Mailing Address - Street 1:10810 PARKSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1983
Mailing Address - Country:US
Mailing Address - Phone:865-392-9220
Mailing Address - Fax:865-392-9221
Practice Address - Street 1:10810 PARKSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1983
Practice Address - Country:US
Practice Address - Phone:865-392-9220
Practice Address - Fax:865-392-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3388082Medicare ID - Type Unspecified