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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
10084027OTHERTNBC/BS & TENNCARE SELECT
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215961461
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF TENNESSEE
Provider Business Mailing Address
First Line : 140 DOVER ST
Second Line :
City : SHELBYVILLE
State : TN
Zip : 37160-2776
Country : US
Telephone Number : 931-684-3426
Fax Number : 931-684-5860
Provider Business Practice Location Address
First Line : 140 DOVER ST
Second Line :
City : SHELBYVILLE
State : TN
Zip : 37160-2776
Country : US
Telephone Number : 931-684-3426
Fax Number : 931-684-5860
Authorized Official
Title or Position : OFFICE SUPERVISOR
Name : BARBARA J WHITWELL
Credential :
Telephone Number : 931-490-8334
Provider Enumeration Date : 07/11/2006
Last Update Date : 09/25/2012

Similar Medicare Providers

1710985072 — JANIS D EBOLUM APRN-BC
Practice Location Address:
140 DOVER ST
SHELBYVILLE, TN
37160-2776
Practice Phone: 931-684-3426
Practice Fax: 931-684-5860
1205985488 — NANCY STOUGHTON BROOKSHIRE FNP
Practice Location Address:
140 DOVER ST
SHELBYVILLE, TN
37160-2776
Practice Phone: 931-684-3426
Practice Fax: 931-684-5860
1255467478 — MRS. AMANDA JOELLEN FINLEY RN
Practice Location Address:
140 DOVER ST
SHELBYVILLE, TN
37160-2776
Practice Phone: 931-684-3426
Practice Fax: 931-684-5860
1972639698 — MRS. TONYA MAY VILLEGAS LPN
Practice Location Address:
140 DOVER ST
SHELBYVILLE, TN
37160-2776
Practice Phone: 931-684-3426
Practice Fax: 931-684-5860
1821128638 — MARTHA TALLEY RN
Practice Location Address:
140 DOVER ST
SHELBYVILLE, TN
37160-2776
Practice Phone: 931-684-3426
Practice Fax:
1851422968 — PROF. KELLY CLIFFORD
Practice Location Address:
140 DOVER ST
SHELBYVILLE, TN
37160-2776
Practice Phone: 931-684-0000
Practice Fax: 931-684-5860

Directions to “STATE OF TENNESSEE ” Practice Location

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