East Tennessee Children'S Primary Care Center, Inc.
Organization Active NPI Pediatrics Physician · Clinton, TN
NPI 1457557134 · NPPES record last updated Sep 5, 2026
Key facts
- NPI
- 1457557134
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- EAST TENNESSEE CHILDREN'S PRIMARY CARE CENTER, INC.
- Practice address
- 2130 N Charles G Seivers Blvd Ste 4
Clinton, TN 37716-6705 - Phone
- (865) 457-4044
- Fax
- (866) 699-4833
- NPI assigned
- Jun 21, 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
Corporate family (same tax ID) 13
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0311248 | East TN Children'S Hosp Primary Care Center, Inc | Certificate of waiver | Apr 20, 2028 |
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
1705 Roane State Hwy
Harriman, TN 37748
Phone (865) 316-5001
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
2130 N Charles G Seivers Blvd Ste 4
Clinton, TN 37716-6705
Mailing address
PO Box 50068
Knoxville, TN 37950-0068
Phone (865) 541-8895
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q002835 | Medicaid | TN |
Other names
- Clinton Pediatrics
- Dolly Parton Children's Hospital Clinton Pediatrics
Other providers in Clinton, TN
- Macy L Diehl
- Elissa Doll
- Tyler Dougherty
- Dr P J Wenk & Dr P a Wenk PC
- Jessica Greenway Dunn
- Scott Edwards
- Jennifer Nicole Everhart
- Everside Health Aisin Clinton
- Susan R Ewing
- Scott A Farmer
All providers in Clinton, 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 Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.