State of Tennessee
Organization Active NPI Psychiatric Hospital · Knoxville, TN
NPI 1467538009 · NPPES record last updated Mar 20, 2012
Key facts
- NPI
- 1467538009
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric Hospital 283Q00000X
- License
- L2161051102 (TN)
- Legal business name
- STATE OF TENNESSEE
- Practice address
- 5908 Lyons View Pike
Knoxville, TN 37919 - Phone
- (865) 584-1561
- Fax
- (865) 450-5203
- NPI assigned
- Oct 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Richard L Thomas
- Title
- Chief Executive Officer - Ceo
- Phone
- (865) 583-8888
Other NPIs on the same Medicare enrollment 10
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031104000309 | TN | Part B Supplier - Clinic/Group Practice | 5698687077 |
Receives reassigned benefits from 91 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Springfield, TN; Nashville, TN; Memphis, TN; Lebanon, TN; Cookeville, TN; Columbia, TN; Chattanooga, TN; Jackson, TN |
National Provider Directory
Locations
5908 Lyons View Pike
Knoxville, TN 37919
Phone (865) 583-8768
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital | 283Q00000X | L2161051102 | TN | Yes |
Addresses
Primary practice location
5908 Lyons View Pike
Knoxville, TN 37919
Mailing address
5908 Lyons View Pike
Knoxville, TN 37919
Phone (865) 584-1561
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0444000 | Medicaid | TN | |
| 3282144 | Other | TN | CIGNA MEDICARE PART B |
| 0010800 | Other | TN | BCBS |
Other names
- Lakeshore Mental Health Institute
Other providers in Knoxville, TN
- Kevin Eric Stasney
- Statcare Inpatient LLC
- Statcare Outpatient, LLC
- State of Tennessee
- State of Tennessee
- State of Tennessee
- State of Tennessee
- State of Tennessee State F & a Payroll
- Mary Staub
- Christian L Stauber
All providers in Knoxville, TN · Psychiatric Hospital in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2012. 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.