Provider Demographics
NPI:1134494297
Name:SULLIVAN COUNTY REGIONAL HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:SULLIVAN COUNTY REGIONAL HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-279-2777
Mailing Address - Street 1:154 BLOUNTVILLE BYP
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-4575
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:154 BLOUNTVILLE BYP
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-4575
Practice Address - Country:US
Practice Address - Phone:423-279-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001231487163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty