Provider Demographics
NPI:1497892343
Name:STATE OF TENNESSEE
Entity Type:Organization
Organization Name:STATE OF TENNESSEE
Other - Org Name:SEQUATCHIE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-634-5832
Mailing Address - Street 1:16939 RANKIN AVE
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-7029
Mailing Address - Country:US
Mailing Address - Phone:423-949-3619
Mailing Address - Fax:423-949-6507
Practice Address - Street 1:16939 RANKIN AVE
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-7029
Practice Address - Country:US
Practice Address - Phone:423-949-3619
Practice Address - Fax:423-949-6507
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENNESEE DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3911059Medicare ID - Type UnspecifiedFLU PROVIDER NUMBER