Provider Demographics
NPI:1346228004
Name:HOSPITALIST GROUP PC
Entity Type:Organization
Organization Name:HOSPITALIST GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-525-0598
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37605-0779
Mailing Address - Country:US
Mailing Address - Phone:423-928-1145
Mailing Address - Fax:423-928-1353
Practice Address - Street 1:211 BLOUNT AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-525-0598
Practice Address - Fax:865-525-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3718274Medicare ID - Type UnspecifiedTN MEDICARE #