Provider Demographics
NPI:1912285057
Name:CHEROKEE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:CHEROKEE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERRY-ARMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-317-9344
Mailing Address - Street 1:6350 W A J HWY
Mailing Address - Street 2:DEPARTMENT 100
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8605
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:150 PIONEER DR
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861-3622
Practice Address - Country:US
Practice Address - Phone:865-225-2188
Practice Address - Fax:865-225-2189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHEROKEE HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-22
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44-1946OtherFQHC CCN