Provider Demographics
NPI:1861526956
Name:LTC PROVIDERS INCORPORATED
Entity type:Organization
Organization Name:LTC PROVIDERS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTIONER
Authorized Official - Phone:865-546-1433
Mailing Address - Street 1:428 E BURWELL AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5007
Mailing Address - Country:US
Mailing Address - Phone:865-546-1433
Mailing Address - Fax:
Practice Address - Street 1:428 E BURWELL AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-5007
Practice Address - Country:US
Practice Address - Phone:865-546-1433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 0000006533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1912081381OtherINDIVIDUAL NPI
TN4133158OtherBCBC TN
TN3906597Medicaid
TN3348732Medicaid
TN4133158OtherBCBC TN
TN1912081381OtherINDIVIDUAL NPI
TN3906597Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
TN3348732Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
TNDD6818Medicare ID - Type UnspecifiedRAILROAD CARRIER
TN3348732Medicaid