Provider Demographics
NPI:1568640456
Name:HEALTH CARE PROVIDER
Entity Type:Organization
Organization Name:HEALTH CARE PROVIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN 2
Authorized Official - Prefix:MS
Authorized Official - First Name:LORINDA
Authorized Official - Middle Name:COOTER
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:423-975-2200
Mailing Address - Street 1:415 STATE OF FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6034
Mailing Address - Country:US
Mailing Address - Phone:423-975-2200
Mailing Address - Fax:
Practice Address - Street 1:415 STATE OF FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6034
Practice Address - Country:US
Practice Address - Phone:423-975-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN144981251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare