Provider Demographics
NPI:1871626895
Name:EAST TENNESSEE EMG, INC.
Entity type:Organization
Organization Name:EAST TENNESSEE EMG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KNORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-531-2204
Mailing Address - Street 1:614 MABRY HOOD RD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-2669
Mailing Address - Country:US
Mailing Address - Phone:865-531-2204
Mailing Address - Fax:888-291-0133
Practice Address - Street 1:614 MABRY HOOD ROAD
Practice Address - Street 2:SUITE #301
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932
Practice Address - Country:US
Practice Address - Phone:865-531-2204
Practice Address - Fax:888-291-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3654053Medicaid
TN4054725OtherBCBS OF TENN
TN4054725OtherBCBS OF TENN