Provider Demographics
NPI:1689047375
Name:HOT ROD SHANNON
Entity Type:Organization
Organization Name:HOT ROD SHANNON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-748-7003
Mailing Address - Street 1:PO BOX 1057
Mailing Address - Street 2:117 COON HUNTER ROAD
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-1057
Mailing Address - Country:US
Mailing Address - Phone:865-748-7003
Mailing Address - Fax:423-346-2139
Practice Address - Street 1:2303 MORGAN COUNTY HWY
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-3528
Practice Address - Country:US
Practice Address - Phone:865-748-7003
Practice Address - Fax:423-346-2139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care