Provider Demographics
NPI:1841200177
Name:LISA ROSS BIRTH AND WOMENS CENTER
Entity Type:Organization
Organization Name:LISA ROSS BIRTH AND WOMENS CENTER
Other - Org Name:THE MATERNITY CENTER OF EAST TENNESSEE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:865-524-4422
Mailing Address - Street 1:1925-B AILOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921
Mailing Address - Country:US
Mailing Address - Phone:865-524-4422
Mailing Address - Fax:865-523-3687
Practice Address - Street 1:1925-B AILOR AVENUE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921
Practice Address - Country:US
Practice Address - Phone:865-524-4422
Practice Address - Fax:865-523-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000004261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1000911OtherBLUE CROSS BLUE SHIELD
TN444B195Medicaid