Provider Demographics
NPI:1316365224
Name:CRESCENT HEALTH SUBOXONE CLINIC
Entity Type:Organization
Organization Name:CRESCENT HEALTH SUBOXONE CLINIC
Other - Org Name:FIRST MED SUBOXONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:GM
Authorized Official - Phone:865-446-4032
Mailing Address - Street 1:190 COMMUNITY CENTER DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37863-6251
Mailing Address - Country:US
Mailing Address - Phone:865-446-4032
Mailing Address - Fax:865-868-4746
Practice Address - Street 1:190 COMMUNITY CENTER DR.
Practice Address - Street 2:SUITE 103
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-6251
Practice Address - Country:US
Practice Address - Phone:865-446-4032
Practice Address - Fax:865-868-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-29
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7429363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7143950006Medicare NSC
7143950005Medicare PIN