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NPI Code Detail

MEDICARE: STATE OF TENNESSEE

MEDICARE: STATE OF TENNESSEE
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
1251K00000XPublic Health or Welfare Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12002854OTHERTNBC/BS & TENNCARE SELECT
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699795468
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF TENNESSEE
Provider Business Mailing Address
First Line : 615 WILSON AVE
Second Line :
City : TULLAHOMA
State : TN
Zip : 37388-3264
Country : US
Telephone Number : 931-455-9369
Fax Number : 931-455-4827
Provider Business Practice Location Address
First Line : 615 WILSON AVE
Second Line :
City : TULLAHOMA
State : TN
Zip : 37388-3264
Country : US
Telephone Number : 931-455-9369
Fax Number : 931-455-4827
Authorized Official
Title or Position : OFFICE SUPERVISOR
Name : BARBARA J WHITWELL
Credential :
Telephone Number : 931-490-8334
Provider Enumeration Date : 07/21/2006
Last Update Date : 09/25/2012

Similar Medicare Providers

1528999786 — DUSTI LOUISE PATTON BSN, RN
Practice Location Address:
615 WILSON AVE
TULLAHOMA, TN
37388-3264
Practice Phone: 931-455-9369
Practice Fax:
1811027543 — CORINNE ANN TROUPE R.N.
Practice Location Address:
615 WILSON AVE
TULLAHOMA, TN
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1831229400 — MRS. TAMERA SUE BIRD
Practice Location Address:
615 WILSON AVE
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37388-3264
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Practice Fax: 931-455-4827
1396875993 — MRS. PAMELA FAYE NORTHCUTT
Practice Location Address:
615 WILSON AVE
TULLAHOMA, TN
37388-3264
Practice Phone: 931-455-9369
Practice Fax: 931-455-4827
1275664070 — MS. VALLERIE ANNESTHER ROSE RN
Practice Location Address:
615 WILSON AVE # L
TULLAHOMA, TN
37388-3264
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Practice Fax: 931-455-4827
1902014855 — MS. ANNE-MARIE SHELTON PENDER RN
Practice Location Address:
615 WILSON AVE
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37388-3264
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Practice Fax:

Directions to “STATE OF TENNESSEE ” Practice Location

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