Provider Demographics
NPI:1407997711
Name:FARRAGUT FAMILY CARE
Entity Type:Organization
Organization Name:FARRAGUT FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:865-549-2121
Mailing Address - Street 1:110 N CAMPBELL STATION RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2753
Mailing Address - Country:US
Mailing Address - Phone:865-675-1953
Mailing Address - Fax:
Practice Address - Street 1:110 N CAMPBELL STATION RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2753
Practice Address - Country:US
Practice Address - Phone:865-675-1953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH VENTURES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-09
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID NUMBER