Provider Demographics
NPI:1457316135
Name:WEST KNOXVILLE HEART, P.C.
Entity Type:Organization
Organization Name:WEST KNOXVILLE HEART, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-690-9475
Mailing Address - Street 1:9314 PARK WEST BLVD
Mailing Address - Street 2:# 300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4328
Mailing Address - Country:US
Mailing Address - Phone:865-690-9475
Mailing Address - Fax:865-690-2033
Practice Address - Street 1:9314 PARK WEST BLVD
Practice Address - Street 2:# 300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4328
Practice Address - Country:US
Practice Address - Phone:865-690-9475
Practice Address - Fax:865-690-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3387937Medicare ID - Type Unspecified