Provider Demographics
NPI:1629066378
Name:FORT SANDERS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:FORT SANDERS REGIONAL MEDICAL CENTER
Other - Org Name:FORT SANDERS REGIONAL INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:GEPPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-374-6872
Mailing Address - Street 1:1420 CENTERPOINT BLVD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1960
Mailing Address - Country:US
Mailing Address - Phone:865-374-5354
Mailing Address - Fax:
Practice Address - Street 1:1901 W CLINCH AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2307
Practice Address - Country:US
Practice Address - Phone:865-331-1860
Practice Address - Fax:865-331-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
TN5703336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017785Medicaid
2092051OtherPK
2092051OtherPK
4430245OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN100020425Medicaid