Provider Demographics
NPI:1265410948
Name:FORT SANDERS REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:FORT SANDERS REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, PATIENT ACCOUNT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-374-3090
Mailing Address - Street 1:DEPT 888001
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-0001
Mailing Address - Country:US
Mailing Address - Phone:865-374-3000
Mailing Address - Fax:
Practice Address - Street 1:1901 CLINCH AVENUE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37995-0001
Practice Address - Country:US
Practice Address - Phone:865-374-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-04
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000325314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN445328Medicare Oscar/Certification