Provider Demographics
NPI:1750382164
Name:COMMUNITY HEALTH OF EAST TENNESSEE, INC
Entity type:Organization
Organization Name:COMMUNITY HEALTH OF EAST TENNESSEE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:W
Authorized Official - Last Name:DABNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-562-1705
Mailing Address - Street 1:130 INDEPENDENCE LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3031
Mailing Address - Country:US
Mailing Address - Phone:423-562-1705
Mailing Address - Fax:423-566-3718
Practice Address - Street 1:130 INDEPENDENCE LN
Practice Address - Street 2:SUITE 1
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3031
Practice Address - Country:US
Practice Address - Phone:423-562-1705
Practice Address - Fax:423-566-3718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN441877OtherFQHC MEDICARE #
TN3340196Medicaid
TN3340196Medicaid
TN3340196Medicare PIN