Organization
HEARTLAND INFUSION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES RAY WALL (OWNER)
(865) 689-9778
Entity
Organization
Contact information
Practice address
9943 KINGSTON PIKE, KNOXVILLE, TN 37922-6923
(865) 862-4557
(865) 862-4556
Mailing address
9943 KINGSTON PIKE, KNOXVILLE, TN 37922-6923
(865) 862-4557
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0575
LOCAL PART B
TN
05
—
1534157
—
TN
Enumeration date
09/21/2018
Last updated
03/02/2021
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