Basic Information
| Provider Information | |||||||||
| NPI: | 1477086981 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STATCARE INPATIENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2240 SUTHERLAND AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379192333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659090090 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2240 SUTHERLAND AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379192333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659090090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2017 | ||||||||
| LastUpdateDate: | 04/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | DOERS | ||||||||
| AuthorizedOfficialFirstName: | JESSE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8659090090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.