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923 E Central Ave La Follette TN 37766-2768 | |
(423) 907-1200 | |
(423) 907-1189 |
Full Name | |
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Speciality | Psychiatric Unit |
Location | 923 E Central Ave, La Follette, Tennessee |
Authorized Official Name and Position | Paula M Lalor (DIRECTOR/DELEGATED OFFICIAL) |
Authorized Official Contact | 6292153953 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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923 E Central Ave La Follette TN 37766-2768 Ph: (423) 907-1200 | 923 E Central Ave La Follette TN 37766-2768 Ph: (423) 907-1200 |
NPI Number | 1548241953 |
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Provider Enumeration Date | 11/11/2005 |
Last Update Date | 03/29/2021 |
Certification Date | 03/29/2021 |
Medicare PECOS PAC ID | 3173795168 |
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Medicare Enrollment ID | O20111121000362 |
Identifier | Type | State | Issuer |
---|---|---|---|
1548241953 | NPI | - | NPPES |
0440033 | Medicaid | TN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
273R00000X | Psychiatric Unit | 0000000008 (Tennessee) | Primary |