Provider Demographics
NPI:1437278363
Name:SPECIALTY MEDICAL
Entity Type:Organization
Organization Name:SPECIALTY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-560-8889
Mailing Address - Street 1:7815B OAK RIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-2314
Mailing Address - Country:US
Mailing Address - Phone:865-560-8889
Mailing Address - Fax:865-560-8862
Practice Address - Street 1:509 N STATE OF FRANKLIN RD
Practice Address - Street 2:SUITE C
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8214
Practice Address - Country:US
Practice Address - Phone:423-232-8885
Practice Address - Fax:423-232-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455072Medicaid
TN4124497OtherBLUE CROSS
TN=========OtherTRI-CARE
TN1455072Medicaid