Provider Demographics
NPI:1821087628
Name:KNOXVILLE HEART GROUP PC
Entity Type:Organization
Organization Name:KNOXVILLE HEART GROUP PC
Other - Org Name:HORIZON CARDIOLOGY GROUP PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:HARDIN
Authorized Official - Last Name:RENFROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-541-4070
Mailing Address - Street 1:1819 W CLINCH AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2434
Mailing Address - Country:US
Mailing Address - Phone:865-546-5111
Mailing Address - Fax:865-541-4018
Practice Address - Street 1:1819 W CLINCH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2434
Practice Address - Country:US
Practice Address - Phone:865-546-5111
Practice Address - Fax:865-541-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3722208Medicaid
TN3722208Medicaid