Provider Demographics
NPI:1134384209
Name:GERIATRIC ASSESMENT PROGRAM
Entity type:Organization
Organization Name:GERIATRIC ASSESMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-549-4340
Mailing Address - Street 1:PO BOX 23740
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37933-1740
Mailing Address - Country:US
Mailing Address - Phone:865-549-4340
Mailing Address - Fax:
Practice Address - Street 1:101 E BLOUNT AVE
Practice Address - Street 2:SUITE 650
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1632
Practice Address - Country:US
Practice Address - Phone:865-632-5058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH VENTURES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704598Medicaid
TN3704598Medicaid