| Organization Name: | EAST TENNESSEE CHILDREN'S HOSPITAL PRIMARY CARE CENTER, INC. |
| NPI Number: | 1265637441 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRACY LANG (PRACTICE ASST ADMIN) |
| Mailing Address: | 125 Mountain View Dr Suite 300 Vonore |
| State: | TN US |
| Postal Code: | 378852666 |
| Phone Number: | 4238842170 |
| Fax Number: | 4238846412 |
| NPI Enumeration Date: | 06/18/2007 |
| NPI Last Update Date: | 09/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |