Organization
EAST TENNESSEE DIALYSIS CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOEEN A HATAB PHD (ADMINISTRATOR)
(865) 681-2900
Entity
Organization
Contact information
Practice address
1629 E BROADWAY AVE, MARYVILLE, TN 37804-2913
(865) 681-2900
(865) 980-0907
Mailing address
PO BOX 32094, KNOXVILLE, TN 37930
(865) 681-2900
(865) 980-0907
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
0000000124
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0442636
—
TN
Enumeration date
03/05/2007
Last updated
01/19/2012
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