Provider Demographics
NPI:1083853105
Name:STATE OF TENNESSEE
Entity Type:Organization
Organization Name:STATE OF TENNESSEE
Other - Org Name:MEMPHIS AND SHELBY COUNTY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING AND OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLI
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:423-307-2330
Mailing Address - Street 1:814 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-5041
Mailing Address - Country:US
Mailing Address - Phone:901-544-7597
Mailing Address - Fax:901-544-7602
Practice Address - Street 1:814 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-5041
Practice Address - Country:US
Practice Address - Phone:901-544-7597
Practice Address - Fax:901-544-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002280291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44D0663079OtherCLIA