Provider Demographics
NPI:1073650461
Name:STATE OF TENNESSEE
Entity Type:Organization
Organization Name:STATE OF TENNESSEE
Other - Org Name:GIBSON COUNTY HEALTH DEPARTMENT TRENTON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-421-6700
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:1250 MANUFACTURES ROW
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382
Mailing Address - Country:US
Mailing Address - Phone:731-855-7601
Mailing Address - Fax:731-855-7603
Practice Address - Street 1:1250 MANUFACTURES ROW
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382
Practice Address - Country:US
Practice Address - Phone:731-855-7601
Practice Address - Fax:731-855-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4448039Medicaid
TN3911389Medicare ID - Type Unspecified