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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
10009421OTHERTNBC/BS & TENNCARE SELECT
2164774OTHERTNDORAL DENTAL
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467486613
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF TENNESSEE
Provider Business Mailing Address
First Line : 51 SMITH AVE
Second Line :
City : HOHENWALD
State : TN
Zip : 38462-1124
Country : US
Telephone Number : 931-796-2204
Fax Number : 931-796-1625
Provider Business Practice Location Address
First Line : 51 SMITH AVE
Second Line :
City : HOHENWALD
State : TN
Zip : 38462-1124
Country : US
Telephone Number : 931-796-2204
Fax Number : 931-796-1625
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

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Directions to “STATE OF TENNESSEE ” Practice Location

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