Provider Demographics
NPI:1710653761
Name:ENCORE INFUSION OF TENNESSEE PC
Entity Type:Organization
Organization Name:ENCORE INFUSION OF TENNESSEE PC
Other - Org Name:HEARTLAND INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-313-9014
Mailing Address - Street 1:PO BOX 32789
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33420-2789
Mailing Address - Country:US
Mailing Address - Phone:561-327-4970
Mailing Address - Fax:561-823-0829
Practice Address - Street 1:10910 KINGSTON PIKE UNIT 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2948
Practice Address - Country:US
Practice Address - Phone:865-862-4557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion TherapyGroup - Multi-Specialty