Provider Demographics
NPI:1508969528
Name:HEALTHCARE CENTER, PC
Entity Type:Organization
Organization Name:HEALTHCARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-219-6055
Mailing Address - Street 1:PO BOX 5870
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5870
Mailing Address - Country:US
Mailing Address - Phone:865-219-6055
Mailing Address - Fax:865-982-5185
Practice Address - Street 1:2908 TAZEWELL PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1878
Practice Address - Country:US
Practice Address - Phone:865-219-6055
Practice Address - Fax:865-982-5185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727258Medicare ID - Type Unspecified