Provider Demographics
NPI:1780617878
Name:PRIORITY HEALTHCARE SERVICES OF TN INC
Entity type:Organization
Organization Name:PRIORITY HEALTHCARE SERVICES OF TN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-584-4010
Mailing Address - Street 1:6900 HOSPITALITY CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1105
Mailing Address - Country:US
Mailing Address - Phone:865-584-4010
Mailing Address - Fax:865-588-2045
Practice Address - Street 1:6900 HOSPITALITY CIR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1105
Practice Address - Country:US
Practice Address - Phone:865-584-4010
Practice Address - Fax:865-588-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000144251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN147680Medicaid
TN147680Medicaid