Provider Demographics
| NPI: | 1629356969 |
|---|---|
| Name: | KNOXVILLE HMA PHYSICIAN MANAGEMENT, LLC |
| Entity Type: | Organization |
| Organization Name: | KNOXVILLE HMA PHYSICIAN MANAGEMENT, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR; AUTHORIZED OFFICIAL |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | MICHAEL |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | SWAW |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 615-778-8076 |
| Mailing Address - Street 1: | 10800 PARKSIDE DR STE 330 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | KNOXVILLE |
| Mailing Address - State: | TN |
| Mailing Address - Zip Code: | 37934-1926 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 877-848-1457 |
| Mailing Address - Fax: | 615-628-6877 |
| Practice Address - Street 1: | 10810 PARKSIDE DR STE 109 |
| Practice Address - Street 2: | |
| Practice Address - City: | KNOXVILLE |
| Practice Address - State: | TN |
| Practice Address - Zip Code: | 37934-1980 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 865-218-7480 |
| Practice Address - Fax: | 865-218-7488 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | COMMUNITY HEALTH SYSTEMS |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2011-08-03 |
| Last Update Date: | 2023-05-15 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207VX0201X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
| No | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | Group - Multi-Specialty |
| No | 363LX0001X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 7100186500 | Medicaid | |
| TN | 1524808 | Medicaid | |
| TN | 1524808 | Medicaid |
