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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
13336I0012XInstitutional Pharmacy
23336L0003XLong Term Care PharmacyL2(16)M21051098TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12088533OTHERPK

General Provider Information

NPI Number : 1104869486
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 : 423-785-3321
Fax Number : 423-785-3454
Provider Business Practice Location Address
First Line : 100 MOCCASIN BEND RD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37405-4415
Country : US
Telephone Number : 423-785-3321
Fax Number : 423-785-3454
Authorized Official
Title or Position : CHIEF OF PHARMACY
Name : JASON CARTER
Credential :
Telephone Number : 615-532-6736
Provider Enumeration Date : 06/14/2006
Last Update Date : 10/14/2014

Similar Medicare Providers

1306818265 — STATE OF TENNESSEE STATE F & A PAYROLL
Practice Location Address:
100 MOCCASIN BEND RD
CHATTANOOGA, TN
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Practice Fax: 423-875-3454
1639112568 — JONATHAN K CHRISTIANSON DO
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1801823125 — GLORIA L BUTLER MD
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1447283809 — DOLOROSA B YAP MD
Practice Location Address:
100 MOCCASIN BEND RD
CHATTANOOGA, TN
37405-4415
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1417980871 — MELONY E MAGOON APN
Practice Location Address:
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1750307716 — BERTHA HUDGINS APN
Practice Location Address:
100 MOCCASIN BEND RD
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37405-4415
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Practice Fax: 423-785-3454

Directions to “STATE OF TENNESSEE STATE F & A PAYROLL ” Practice Location

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