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General NPI Number Information
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NPI Number | 1437201837
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Entity Type | Organization
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Legal Business Name | STATE OF TENNESSEE
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1401 SPARTA ST
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City | MC MINNVILLE
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State | TN
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Zip | 37110-1301
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Country | US
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Telephone | 931-473-8468
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Fax | 931-473-0595
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Provider Business Mailing Address
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Address Line | 1100 ENGLAND DRIVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-0924
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Country | US
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Telephone | 931-520-4201
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Fax | 931-520-3871
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Authorized Official
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Title or Position | CFO
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Name | TAMMY STEWART
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Credential |
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Telephone | 931-520-4203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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