Provider Demographics
NPI:1669068185
Name:THE IAOMAI CENTER, LLC
Entity type:Organization
Organization Name:THE IAOMAI CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TANKERSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-238-4224
Mailing Address - Street 1:404 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4613
Mailing Address - Country:US
Mailing Address - Phone:865-238-4224
Mailing Address - Fax:
Practice Address - Street 1:108 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5740
Practice Address - Country:US
Practice Address - Phone:865-238-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty