MEDICARE: GRUNDY COUNTY HEALTH SERVICES, INC.

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	363LF0000X	Family Nurse Practitioner

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
2	1750962528	OTHER	TN	NPI

General Provider Information

NPI Number	:	1770588683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRUNDY COUNTY HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	740 MAIN ST
Second Line	:	PO BOX 1449
City	:	TRACY CITY
State	:	TN
Zip	:	37387-1449
Country	:	US
Telephone Number	:	931-592-4242
Fax Number	:	931-592-4245

Provider Business Practice Location Address
First Line	:	740 MAIN ST
Second Line	:
City	:	TRACY CITY
State	:	TN
Zip	:	37387-4020
Country	:	US
Telephone Number	:	931-592-4242
Fax Number	:	931-592-4245

Authorized Official
Title or Position	:	NURSE PRACTITIONER- PROVIDER
Name	:	DEVON BREA LANGLEY
Credential	:	FNP-C
Telephone Number	:	931-592-4242

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	04/01/2025

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