Provider Demographics
NPI:1134324510
Name:WOMENS CENTER OF EAST TENNESSEE PC
Entity Type:Organization
Organization Name:WOMENS CENTER OF EAST TENNESSEE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-339-1400
Mailing Address - Street 1:2301 N OCOEE ST STE A
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3869
Mailing Address - Country:US
Mailing Address - Phone:423-339-1400
Mailing Address - Fax:423-339-9950
Practice Address - Street 1:135 N MEADOWS DR STE B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4172
Practice Address - Country:US
Practice Address - Phone:423-507-8067
Practice Address - Fax:423-507-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3710254Medicare PIN