Provider Demographics
NPI:1497943583
Name:ST. MARY'S CARDIOLOGY, LLC
Entity Type:Organization
Organization Name:ST. MARY'S CARDIOLOGY, LLC
Other - Org Name:JEFFERSON HEART CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-545-7558
Mailing Address - Street 1:900 E OAK HILL AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4505
Mailing Address - Country:US
Mailing Address - Phone:865-545-8000
Mailing Address - Fax:865-545-3105
Practice Address - Street 1:120 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5281
Practice Address - Country:US
Practice Address - Phone:865-471-2570
Practice Address - Fax:865-471-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370225Medicare PIN