Provider Demographics
NPI:1891808853
Name:THE POUCH PLACE, INC.
Entity Type:Organization
Organization Name:THE POUCH PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BERYL
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:RN MS CWON
Authorized Official - Phone:865-531-1285
Mailing Address - Street 1:8805 KINGSTON PIKE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5017
Mailing Address - Country:US
Mailing Address - Phone:865-531-1285
Mailing Address - Fax:865-690-0769
Practice Address - Street 1:8805 KINGSTON PIKE
Practice Address - Street 2:SUITE 106
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5017
Practice Address - Country:US
Practice Address - Phone:865-531-1285
Practice Address - Fax:865-690-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3562662Medicaid
TN0138932OtherBCBS
TN0138932OtherBCBS