Organization Active NPI

East Tennessee Children's Hospital Association Inc.

Doing business as East Tennessee Children's Hospital Pediatric and Adolescent Gynecology

  • Gynecology Physician
  • Knoxville, TN
National Provider Identifier
1184247181
Registry record updated Jan 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
Legal business name
EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION INC.
Doing business as
East Tennessee Children's Hospital Pediatric and Adolescent Gynecology
Practice address
2100 Clinch Ave Ste 310
Knoxville, TN 37916-2220
Phone
(865) 546-0221
Fax
(866) 323-3153
NPI assigned
May 26, 2020
Organization subpart
Yes
Parent organization
EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrew Rosendahl
Title
Chief Financial Officer
Phone
(865) 541-8154

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VG0400X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X

Addresses

Primary practice location

2100 Clinch Ave Ste 310
Knoxville, TN 37916-2220

Mailing address

PO Box 15004
Knoxville, TN 37901-5004
Phone (865) 546-0221

Other identifiers 1

IdentifierTypeStateIssuer
Q057240MedicaidTN

Other names 1

  • East Tennessee Children's Hospital Pediatric and Adolescent Gynecology Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2189232Pediatric and Adolescent Gynecology2100 Clinch Ave Suite 310, Knoxville, TN 37916Certificate of waiverJul 27, 2026

National Provider Directory

National Provider Directory
Part of
East Tennessee Children's

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768348800000",
    "number": "1184247181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15004",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379015004",
            "telephone_number": "865-546-0221",
            "fax_number": "866-323-3153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 CLINCH AVE STE 310",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379162220",
            "telephone_number": "865-546-0221",
            "fax_number": "866-323-3153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION INC.",
        "enumeration_date": "2020-05-26",
        "last_updated": "2026-01-14",
        "certification_date": "2026-01-14",
        "status": "A",
        "authorized_official_last_name": "ROSENDAHL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "865-541-8154"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q057240",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Tennessee Children's Hospital Pediatric and Adolescent Gynecology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.