=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245386010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STATE OF TENNESSEE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 11/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 TREASURE LANE
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-979-3200
-----------------------------------------------------
Fax | 423-979-3267
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 TREASURE LANE
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-979-3200
-----------------------------------------------------
Fax | 423-979-3267
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL DIRECTOR
-----------------------------------------------------
Name | MRS. REBEKAH ENGLISH
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 423-979-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------