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PED443303-03 East Tennessee Children’s Hospital (Active)
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Main Details
Name
East Tennessee Children’s Hospital
Subdivision Name
Rehabilitation Services - Main Campus - Physical Therapy
Type
Children's Hospital
Rural
No
340B ID
PED443303-03
Medicare Provider Number
443303
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/11/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/6/2024
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
East Tennessee Childrens Hospital
Caryn Hawthorne, Chief Financial Officer
(865) 541-8154
Primary Contact
East Tennessee Children's Hospital Assoc, Inc
Derek Phillips, Outpatient Pharmacy Manager
(865) 541-8980
Addresses
Street Address
2100 Clinch Avenue
Suite 130
Knoxville, TN 37916
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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