Provider Demographics
NPI:1922138262
Name:INTERNAL MEDICINCE WEST A MEMBER OF COVENANT HEALTH
Entity Type:Organization
Organization Name:INTERNAL MEDICINCE WEST A MEMBER OF COVENANT HEALTH
Other - Org Name:INTERNAL MEDICINE WEST, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-374-5100
Mailing Address - Street 1:1400 CENTERPOINT BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1979
Mailing Address - Country:US
Mailing Address - Phone:865-374-5200
Mailing Address - Fax:865-374-5201
Practice Address - Street 1:9330 PARK WEST BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4308
Practice Address - Country:US
Practice Address - Phone:865-690-3003
Practice Address - Fax:865-690-6404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-06
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3712087Medicaid
TN3712087Medicaid