MEDICARE: TENNESEE DEPARTMENT OF HEALTH

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
1	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265570600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESEE DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	1301 RIVERFRONT PKWY STE 209
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-3312
Country	:	US
Telephone Number	:	423-634-5832
Fax Number	:	423-634-3186

Provider Business Practice Location Address
First Line	:	1501 RIVERSIDE DR STE 120
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37406-4332
Country	:	US
Telephone Number	:	423-634-3110
Fax Number	:	423-634-5848

Authorized Official
Title or Position	:	ACCOUNTING MANAGER
Name	:	MR. RICHARD WAYNE MCCARTHY
Credential	:	MBA
Telephone Number	:	423-634-5832

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	09/10/2019

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Directions to “TENNESEE DEPARTMENT OF HEALTH ” Practice Location

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