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NPI Code Detail

MEDICARE: STATE OF TENNESSEE STATE F & A PAYROLL

MEDICARE: STATE OF TENNESSEE STATE F & A PAYROLL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1273R00000XPsychiatric Hospital Unit

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306818265
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF TENNESSEE STATE F & A PAYROLL
Provider Business Mailing Address
First Line : 100 MOCCASIN BEND RD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37405-4415
Country : US
Telephone Number : 423-265-2271
Fax Number : 423-875-3454
Provider Business Practice Location Address
First Line : 100 MOCCASIN BEND RD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37405-4415
Country : US
Telephone Number : 423-265-2271
Fax Number : 423-875-3454
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. RODNEY HENDERSON
Credential :
Telephone Number : 423-785-3321
Provider Enumeration Date : 02/06/2006
Last Update Date : 03/31/2022

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1447283809 — DOLOROSA B YAP MD
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1417980871 — MELONY E MAGOON APN
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Directions to “STATE OF TENNESSEE STATE F & A PAYROLL ” Practice Location

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