East Tennessee Children'S Primary Care Center, Inc.
Organization Active NPI Pediatrics Physician · Vonore, TN
NPI 1265637441 · NPPES record last updated Sep 5, 2026
Key facts
- NPI
- 1265637441
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- EAST TENNESSEE CHILDREN'S PRIMARY CARE CENTER, INC.
- Practice address
- 125 Mountain View Dr Ste 200
Vonore, TN 37885-2666 - Phone
- (423) 884-2170
- Fax
- (866) 330-9583
- NPI assigned
- Jun 18, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- EAST TENNESSEE CHILDREN'S 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
Member of 1
Practitioners 2
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
611 22nd St
Knoxville, TN 37916
Phone (865) 522-4153
125 Mountain View Dr
Ste 200
Vonore, TN 37885
Phone (423) 884-2170
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes | ||
| Primary Care Clinic/Center | 261QP2300X | |||
| Family Nurse Practitioner |
363LF0000X | |||
| Pediatric Nurse Practitioner |
363LP0200X |
Addresses
Primary practice location
125 Mountain View Dr Ste 200
Vonore, TN 37885-2666
Mailing address
PO Box 50068
Knoxville, TN 37950-0068
Phone (865) 541-8895
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q002814 | Medicaid | TN |
Other names
- Dolly Parton Children's Hospital Vonore Pediatrics
- Vonore Pediatrics
Other providers in Vonore, TN
- Danny R Alexander
- Ellen W. Dash
- Shawn Christian Davies
- James Forrest Devoe II
- Andre M Durand
- Edward Stephen Ellis
- Robert Michael Ferraro
- Richard K Fisher
- Foster Family Eyecare
- Eric Peter Fugate
All providers in Vonore, 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.