NPIMap

Organization Active NPI

East Tennessee Children's Hospital Association, Inc.

Doing business as East Tennessee Children's Hospital Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Knoxville, TN
National Provider Identifier
1528635455
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.
Doing business as
East Tennessee Children's Hospital Outpatient Pharmacy
Practice address
2018 Clinch Avenue
Outpatient Pharmacy
Knoxville, TN 37916-2301
Phone
(865) 541-8980
Fax
(865) 541-8429
NPI assigned
Jun 9, 2021
Organization subpart
Yes
Parent organization
EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Authorized official

Name
Mr. Steven R Godbold
Title
Vice President - Operations
Phone
(865) 541-8492

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

2018 Clinch Avenue
Outpatient Pharmacy
Knoxville, TN 37916-2301

Mailing address

2018 Clinch Avenue
Outpatient Pharmacy
Knoxville, TN 37916-2301
Phone (865) 541-8980

Other identifiers 1

IdentifierTypeStateIssuer
Q066560OtherTNSTATE OF TN DEPARTMENT OF HEALTH

Other names 1

  • East Tennessee Children's Hospital Outpatient Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210802000378 TN Part B Supplier - Pharmacy 6204817661 Practice locations: Knoxville, TN

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
East Tennessee Children's28 organizations share this tax ID, including this one
Part of
East Tennessee Children's

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Locations

2018 Clinch Ave
Ste 210
Knoxville, TN 37916
Phone (865) 523-5437

2100 Clinch Ave
Ste 310
Knoxville, TN 37916
Phone (865) 637-8481

2018 Clinch Ave
Fl 1
Knoxville, TN 37916
Phone (865) 637-8481

2016 Clinch Ave SW
Knoxville, TN 37916
Phone (865) 546-7711

2100 Clinch Ave
Ste 420
Knoxville, TN 37916
Phone (865) 522-0420

207 E Emory Rd
Powell, TN 37849
Phone (865) 637-8481

502 Winfield Dunn Pkwy
Sevierville, TN 37876
Phone (865) 637-8481

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
East Tennessee Children's Hospital Home Health CareKnoxville, TN, CCN 447465 Home health agency Operational/Managerial Control (100%) Jan 26, 1966

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1528635455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2018 CLINCH AVENUE",
            "address_2": "OUTPATIENT PHARMACY",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379162301",
            "telephone_number": "865-541-8980",
            "fax_number": "865-541-8429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2018 CLINCH AVENUE",
            "address_2": "OUTPATIENT PHARMACY",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379162301",
            "telephone_number": "865-541-8980",
            "fax_number": "865-541-8429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.",
        "enumeration_date": "2021-06-09",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "GODBOLD",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "VICE PRESIDENT - OPERATIONS",
        "authorized_official_telephone_number": "865-541-8492",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF TN DEPARTMENT OF HEALTH",
            "identifier": "Q066560",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Tennessee Children's Hospital Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Tennessee Children's Hospital Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.