Provider Demographics
NPI:1790561413
Name:GI FOR KIDS DISPENSARY
Entity Type:Organization
Organization Name:GI FOR KIDS DISPENSARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:865-546-3998
Mailing Address - Street 1:1975 TOWN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-6638
Mailing Address - Country:US
Mailing Address - Phone:865-546-3998
Mailing Address - Fax:865-546-1123
Practice Address - Street 1:1975 TOWN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6638
Practice Address - Country:US
Practice Address - Phone:865-546-3998
Practice Address - Fax:865-546-1123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GI FOR KIDS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-07
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ018806Medicaid