Provider Demographics
NPI:1942520713
Name:CEDARS HEALTHCARE LLC
Entity Type:Organization
Organization Name:CEDARS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, FNP-BC
Authorized Official - Phone:865-803-5717
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:TN
Mailing Address - Zip Code:37820-0415
Mailing Address - Country:US
Mailing Address - Phone:865-475-6100
Mailing Address - Fax:865-475-6106
Practice Address - Street 1:1004 N HIGHWAY 92
Practice Address - Street 2:SUITE C
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-3687
Practice Address - Country:US
Practice Address - Phone:865-475-6100
Practice Address - Fax:865-475-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0101110261QH0100X
TNAPN7024261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS30642Medicare UPIN