Provider Demographics
NPI:1740415025
Name:JEFFERSON HEARTS CONSULTANTS
Entity Type:Organization
Organization Name:JEFFERSON HEARTS CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-549-4892
Mailing Address - Street 1:120 HOSPITAL DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-5287
Mailing Address - Country:US
Mailing Address - Phone:865-471-2570
Mailing Address - Fax:865-471-2571
Practice Address - Street 1:120 HOSPITAL DR
Practice Address - Street 2:SUITE 250
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5287
Practice Address - Country:US
Practice Address - Phone:865-471-2570
Practice Address - Fax:865-471-2571
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY PHYSICIAN SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-15
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373630Medicare Oscar/Certification