Provider Demographics
NPI:1720382336
Name:MEN'S HEALTH MANAGEMENT OF EAST TENNESSEE
Entity Type:Organization
Organization Name:MEN'S HEALTH MANAGEMENT OF EAST TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCOTHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-690-0602
Mailing Address - Street 1:9724 KINGSTON PIKE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3347
Mailing Address - Country:US
Mailing Address - Phone:865-690-0602
Mailing Address - Fax:865-690-0515
Practice Address - Street 1:10820 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1956
Practice Address - Country:US
Practice Address - Phone:865-690-0602
Practice Address - Fax:865-690-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty