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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
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20141402OTHERTNBC/BS & TENNCARE SELECT
34794OTHERTNDORAL DENTAL

General Provider Information

NPI Number : 1922029743
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF TENNESSEE
Provider Business Mailing Address
First Line : 1000 WASHINGTON ST W
Second Line : SUITE A
City : FAYETTEVILLE
State : TN
Zip : 37334-2872
Country : US
Telephone Number : 931-433-3231
Fax Number : 931-438-1567
Provider Business Practice Location Address
First Line : 1000 WASHINGTON ST W
Second Line : SUITE A
City : FAYETTEVILLE
State : TN
Zip : 37334-2872
Country : US
Telephone Number : 931-433-3231
Fax Number : 931-438-1567
Authorized Official
Title or Position : OFFICE SUPERVISOR
Name : BARBARA J WHITWELL
Credential :
Telephone Number : 931-490-8334
Provider Enumeration Date : 07/21/2006
Last Update Date : 09/25/2012

Similar Medicare Providers

1518093590 — MRS. SHARON DENISE HONEA NA
Practice Location Address:
1000 WASHINGTON ST W STE A
FAYETTEVILLE, TN
37334-2872
Practice Phone: 931-433-3231
Practice Fax: 931-438-1567
1225164155 — MRS. CYNTHIA KAY MOOREHEAD RN
Practice Location Address:
1000 WASHINGTON ST W
FAYETTEVILLE, TN
37334-2872
Practice Phone: 931-433-3231
Practice Fax: 931-438-1567
1497881395 — MS. CYNTHIA FOGG ESLICK RN
Practice Location Address:
1000 WASHINGTON ST W , SUITE A
FAYETTEVILLE, TN
37334-2872
Practice Phone: 931-433-3231
Practice Fax: 931-438-1567
1588795173 — MRS. JADA LOANNE HELUMS R.N.
Practice Location Address:
1000 WASHINGTON ST W STE A
FAYETTEVILLE, TN
37334-2872
Practice Phone: 931-433-3231
Practice Fax: 931-438-1567
1376731364 — LESLEY K DAVIDSON RN
Practice Location Address:
1000 WASHINGTON ST W STE A
FAYETTEVILLE, TN
37334-2872
Practice Phone: 931-433-3231
Practice Fax: 931-438-1567
1043409949 — MRS. JOAN BUTLER CARTER RN
Practice Location Address:
1000 WASHINGTON ST W , SUITE A
FAYETTEVILLE, TN
37334-2872
Practice Phone: 931-433-3231
Practice Fax: 931-438-1567

Directions to “STATE OF TENNESSEE ” Practice Location

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