Provider Demographics
NPI:1558675728
Name:TENNESSEE DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:TENNESSEE DEPARTMENT OF HEALTH
Other - Org Name:STEWART COUNTY COMMUNITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAILLENCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-232-5329
Mailing Address - Street 1:425 5TH AVE N
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37243-3400
Mailing Address - Country:US
Mailing Address - Phone:615-741-4733
Mailing Address - Fax:615-532-2286
Practice Address - Street 1:1021 SPRING ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-3302
Practice Address - Country:US
Practice Address - Phone:931-232-5329
Practice Address - Fax:931-232-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000001638251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1503176Medicaid
TN1503176Medicaid