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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
2261QD0000XDental Clinic/Center
3261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

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

General Provider Information

NPI Number : 1487705414
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF TENNESSEE
Provider Business Mailing Address
First Line : 1100 ENGLAND DRIVE
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-0924
Country : US
Telephone Number : 931-520-4201
Fax Number : 931-520-3871
Provider Business Practice Location Address
First Line : 1503 SOUTH MAIN STREET
Second Line :
City : CROSSVILLE
State : TN
Zip : 38555-5967
Country : US
Telephone Number : 931-484-6196
Fax Number : 931-456-1047
Authorized Official
Title or Position : CFO
Name : TAMMY STEWART
Credential :
Telephone Number : 931-520-4203
Provider Enumeration Date : 01/16/2007
Last Update Date : 01/07/2025

Similar Medicare Providers

1720082548 — DR. MATTHEW BOLTON MD
Practice Location Address:
1503 S MAIN ST
CROSSVILLE, TN
38555-5967
Practice Phone: 931-484-6196
Practice Fax: 931-456-1047
1578559282 — DR. ELIZABETH JUNE CONLEY DMD
Practice Location Address:
1503 S MAIN ST
CROSSVILLE, TN
38555-5967
Practice Phone: 931-484-6196
Practice Fax: 931-456-1047
1629091855 — DR. DANNY RAY HALL MD
Practice Location Address:
1503 S MAIN ST
CROSSVILLE, TN
38555-5967
Practice Phone: 931-484-6196
Practice Fax: 931-456-1047
1053629691 — MS. LAURA LYNN HUGHES-HUDGINS LISW-S
Practice Location Address:
1503 S MAIN ST
CROSSVILLE, TN
38555-5967
Practice Phone: 931-484-6196
Practice Fax: 931-456-1047
1558656157 — JENNIFER MARIE THOMPSON FNP-BC
Practice Location Address:
1503 S MAIN ST
CROSSVILLE, TN
38555-5967
Practice Phone: 931-484-6196
Practice Fax:
1346594298 — MRS. ANDREA LEIGH WHITCOMB FNP-BC
Practice Location Address:
1503 S MAIN ST
CROSSVILLE, TN
38555-5967
Practice Phone: 931-484-6196
Practice Fax:

Directions to “STATE OF TENNESSEE ” Practice Location

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