Provider Demographics
NPI:1770681652
Name:UNIVERSITY HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:UNIVERSITY HEALTH SYSTEM, INC
Other - Org Name:LAKEMOOR FAMILY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-305-6427
Mailing Address - Street 1:PO BOX 415000-MSC8143
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37241-8143
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6198
Practice Address - Street 1:3114 ALCOA HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-4791
Practice Address - Country:US
Practice Address - Phone:865-577-0320
Practice Address - Fax:865-573-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709366Medicaid
TNDD1006Medicare PIN
TN3709366Medicare PIN