Organization Active NPI

East Tennessee Pathology, PLLC

  • Clinical Medical Laboratory
  • Morristown, TN
National Provider Identifier
1194011080
Registry record updated Jun 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
EAST TENNESSEE PATHOLOGY, PLLC
Practice address
908 W 4TH North St
Morristown-Hamblen Hospital
Morristown, TN 37814-3894
Phone
(423) 586-4231
Fax
(423) 585-3388
NPI assigned
Jun 20, 2011
Last updated
Jun 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2011

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

Authorized official

Name
Izabela T Burja, MD
Title
Sole Proprietor
Phone
(423) 586-4231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

908 W 4TH North St
Morristown-Hamblen Hospital
Morristown, TN 37814-3894

Mailing address

908 W 4TH North St
Morristown-Hamblen Hospital
Morristown, TN 37814-3894
Phone (423) 586-4231

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110721000506 TN Part B Supplier - Clinic/Group Practice 7416125281 Receives reassigned benefits from 7 practitioners
Practice locations: Jefferson City, TN; Knoxville, TN; Morristown, TN; Powell, TN

National Provider Directory

National Provider Directory

Locations

Dept 888234
Knoxville, TN 37995

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308528000000",
    "number": "1194011080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 W 4TH NORTH ST",
            "address_2": "MORRISTOWN-HAMBLEN HOSPITAL",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378143894",
            "telephone_number": "423-586-4231",
            "fax_number": "423-585-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 W 4TH NORTH ST",
            "address_2": "MORRISTOWN-HAMBLEN HOSPITAL",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378143894",
            "telephone_number": "423-586-4231",
            "fax_number": "423-585-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE PATHOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-20",
        "last_updated": "2011-06-20",
        "status": "A",
        "authorized_official_last_name": "BURJA",
        "authorized_official_first_name": "IZABELA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "423-586-4231",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morristown, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.