East Tennessee Children'S Primary Care Center, Inc.
Organization Active NPI Pediatrics Physician · Knoxville, TN
NPI 1235640467 · NPPES record last updated Sep 5, 2026
Key facts
- NPI
- 1235640467
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- EAST TENNESSEE CHILDREN'S PRIMARY CARE CENTER, INC.
- Practice address
- 10857 Hardin Valley Rd
Knoxville, TN 37932-1410 - Phone
- (865) 690-2682
- Fax
- (866) 529-5509
- NPI assigned
- Oct 16, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- EAST TENNESSEE CHILDREN'S HOSPITAL PRIMARY CARE CENTER, INC.
Authorized official
- Name
- Andrew Rosendahl
- Title
- Chief Financial Officer
- Phone
- (865) 541-8154
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 13
Practitioners 8
-
Kimberly R Fisher, D.O.
-
Charles Stephen Perry, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190411002554 | TN | Part B Supplier - Clinic/Group Practice | 2961783626 |
Receives reassigned benefits from 5 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Knoxville, TN; Vonore, TN; Seymour, TN; Sevierville, TN; Oak Ridge, TN; Maryville, TN; La Follette, TN; Greeneville, TN… |
National Provider Directory
- Tax ID family
- East Tennessee Children'S Hospital Primary Care Center Inc
- Part of
- East Tennessee Children'S Hospital Primary Care Center Inc
Locations
211 N Main St
Greeneville, TN 37745
Phone (423) 787-6050
4600 Asheville Hwy
Knoxville, TN 37914
Phone (865) 522-8114
225 S Peters Rd
Ste 105
Knoxville, TN 37923
7733 Oak Ridge Hwy
Knoxville, TN 37931
Phone (865) 470-2560
2221 Jacksboro Pike
Ste C4
La Follette, TN 37766
Phone (423) 566-3488
414 Greenbelt Dr
Maryville, TN 37804
Phone (865) 637-8812
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes | ||
| Primary Care Clinic/Center | 261QP2300X | |||
| Pediatric Nurse Practitioner |
363LP0200X |
Addresses
Primary practice location
10857 Hardin Valley Rd
Knoxville, TN 37932-1410
Mailing address
PO Box 50068
Knoxville, TN 37950-0068
Phone (865) 541-8895
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q035765 | Medicaid | TN |
Other names
- Dolly Parton Children's Hospital Hardin Valley Pediatrics
- Hardin Valley Pediatrics
Other providers in Knoxville, TN
- East Tennessee Children'S Hospital Association, Inc.
- East Tennessee Children'S Hospital Association, Inc.
- East Tennessee Children'S Hospital Association, Inc.
- East Tennessee Children'S Hospital Primary Care Center, Inc.
- East Tennessee Children'S Primary Care Center, Inc.
- East Tennessee Children'S Primary Care Center, Inc.
- East Tennessee Children'S Primary Care Center, Inc.
- East Tennessee Childrens Hospital Association Inc
- East Tennessee Colon & Rectal Surgical Associates PC
- East Tennessee Community Open MRI
All providers in Knoxville, TN · Pediatrics Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.