Provider Demographics
NPI:1003811381
Name:FORT SANDERS PERINATAL CENTER
Entity Type:Organization
Organization Name:FORT SANDERS PERINATAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-331-2031
Mailing Address - Street 1:501 19TH ST
Mailing Address - Street 2:STE 401
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1839
Mailing Address - Country:US
Mailing Address - Phone:865-331-2020
Mailing Address - Fax:865-331-1976
Practice Address - Street 1:501 19TH ST
Practice Address - Street 2:STE 304
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1839
Practice Address - Country:US
Practice Address - Phone:865-541-2020
Practice Address - Fax:865-541-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNNO GROUP LICENSE207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717963Medicare PIN