Provider Demographics
NPI:1326185307
Name:TENNESSEE DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:TENNESSEE DEPARTMENT OF HEALTH
Other - Org Name:MCMINN COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTANT 3
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-634-5832
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371-0665
Mailing Address - Country:US
Mailing Address - Phone:423-745-7431
Mailing Address - Fax:423-744-1604
Practice Address - Street 1:393 COUNTY ROAD 554
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-6420
Practice Address - Country:US
Practice Address - Phone:423-745-7431
Practice Address - Fax:423-744-7604
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF TENNESSEE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3911013Medicare ID - Type UnspecifiedFLU PROVIDER NUMER