Provider Demographics
NPI:1760476659
Name:EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION INC.
Entity Type:Organization
Organization Name:EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION INC.
Other - Org Name:EAST TENNESSEE CHILDREN'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO / VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-541-8181
Mailing Address - Street 1:PO BOX 15010
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5010
Mailing Address - Country:US
Mailing Address - Phone:865-541-8000
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:2018 W CLINCH AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2301
Practice Address - Country:US
Practice Address - Phone:865-541-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000041282NC2000X
TN3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0443303Medicaid
TN0443303Medicaid