Provider Demographics
NPI:1801150362
Name:TN RIVER MEDICINE, INC
Entity type:Organization
Organization Name:TN RIVER MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-690-1255
Mailing Address - Street 1:259 N PETERS RD
Mailing Address - Street 2:STE 103
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4923
Mailing Address - Country:US
Mailing Address - Phone:865-690-1255
Mailing Address - Fax:865-690-4583
Practice Address - Street 1:259 N PETERS RD
Practice Address - Street 2:STE 103
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4923
Practice Address - Country:US
Practice Address - Phone:865-690-1255
Practice Address - Fax:865-690-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528660Medicaid
TN1528660Medicaid