Provider Demographics
NPI:1700064060
Name:HOSPITALISTS OF EAST TENNESSEE, PC
Entity Type:Organization
Organization Name:HOSPITALISTS OF EAST TENNESSEE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAVER
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHATTUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-273-1752
Mailing Address - Street 1:PO BOX 4156
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-4156
Mailing Address - Country:US
Mailing Address - Phone:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5015
Practice Address - Country:US
Practice Address - Phone:865-983-7211
Practice Address - Fax:865-273-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G705121Medicare PIN