Provider Demographics
NPI:1265674550
Name:SPECTRUM HEALTH ASSOCIATES LLC
Entity Type:Organization
Organization Name:SPECTRUM HEALTH ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:E
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-384-0007
Mailing Address - Street 1:2620 MINERAL SPRINGS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-1570
Mailing Address - Country:US
Mailing Address - Phone:865-219-6968
Mailing Address - Fax:865-219-8636
Practice Address - Street 1:2620 MINERAL SPRINGS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1569
Practice Address - Country:US
Practice Address - Phone:865-219-6968
Practice Address - Fax:865-219-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000030531207R00000X
TNMD0000027033207R00000X
TNMD0000039023207R00000X
TNMD0000027527207R00000X
TNMD0000020655207R00000X
TNMD0000026566207R00000X
TNMD00000196652084P0800X
TNPA0000000518363A00000X
TNRN0000077192363L00000X
TNAPN000006240363LF0000X
TN15673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty