Provider Demographics
NPI:1558408500
Name:TENNESEE DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:TENNESEE DEPARTMENT OF HEALTH
Other - Org Name:BRADLEY 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:W
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-634-5832
Mailing Address - Street 1:201 DOOLEY ST SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-6220
Mailing Address - Country:US
Mailing Address - Phone:423-728-7020
Mailing Address - Fax:423-479-6130
Practice Address - Street 1:201 DOOLEY ST SE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-6220
Practice Address - Country:US
Practice Address - Phone:423-728-7020
Practice Address - Fax:423-479-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
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
TN3910977Medicare ID - Type UnspecifiedFLU PROVIDER NUMBER