Basic Information
| Provider Information | |||||||||
| NPI: | 1821087628 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KNOXVILLE HEART GROUP PC | ||||||||
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| OtherOrganizationName: | HORIZON CARDIOLOGY GROUP PC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1819 W CLINCH AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379162434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655465111 | ||||||||
| FaxNumber: | 8655414018 | ||||||||
| Practice Location | |||||||||
| Address1: | 1819 W CLINCH AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379162434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655465111 | ||||||||
| FaxNumber: | 8655414018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 08/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | RENFROE | ||||||||
| AuthorizedOfficialFirstName: | BRANDON | ||||||||
| AuthorizedOfficialMiddleName: | HARDIN | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 8655414070 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 3722208 | 05 | TN | MEDICAID |