Provider Demographics
NPI:1104023704
Name:ROANE MEDICAL CENTER
Entity Type:Organization
Organization Name:ROANE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-882-4440
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-1090
Mailing Address - Country:US
Mailing Address - Phone:865-882-4440
Mailing Address - Fax:865-882-4447
Practice Address - Street 1:412 DEVONIA ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2009
Practice Address - Country:US
Practice Address - Phone:865-882-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-28
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000030128207R00000X
TNMD0000038366207R00000X
TNMD0000010526207R00000X
TNMD42907207R00000X
TNMD27725207R00000X
TNMD0000039076207RI0200X
TNMD0000041558208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982884656OtherNPI
1083633879OtherNPI
TN30009991Medicare PIN
1083633879OtherNPI
G46994Medicare UPIN
TN3258309Medicare PIN