Basic Information
| Provider Information | |||||||||
| NPI: | 1073835435 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MORRISTOWN HAMBLEN HOSPITAL | ||||||||
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| OtherOrganizationName: | ADVANCED WOMEN'S HEALTH SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 888229 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379958229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656706199 | ||||||||
| FaxNumber: | 8656706188 | ||||||||
| Practice Location | |||||||||
| Address1: | 1633 W MORRIS BLVD | ||||||||
| Address2: | STE A | ||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378133875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235878700 | ||||||||
| FaxNumber: | 4235818444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2010 | ||||||||
| LastUpdateDate: | 09/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | IVEY | ||||||||
| AuthorizedOfficialFirstName: | TONIA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4235878700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1518350 | 05 | TN | MEDICAID |