Provider Demographics
NPI:1275811713
Name:KNOXVILLE HMA CARDIOLOGY PPM, LLC
Entity Type:Organization
Organization Name:KNOXVILLE HMA CARDIOLOGY PPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR; AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-778-8076
Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:615-778-8524
Mailing Address - Fax:615-628-6877
Practice Address - Street 1:1225 E WEISGARBER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2604
Practice Address - Country:US
Practice Address - Phone:865-602-6700
Practice Address - Fax:865-602-6801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-02
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524771Medicaid
KY7100186590Medicaid
TN1524771Medicaid
KY7100186590Medicaid