Provider Demographics
NPI:1689728750
Name:STATE OF TENNESSEE
Entity Type:Organization
Organization Name:STATE OF TENNESSEE
Other - Org Name:HANCOCK CO HEALTH DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY DIRECTOR 3
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VENABLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-733-2228
Mailing Address - Street 1:178 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SNEEDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37869-3666
Mailing Address - Country:US
Mailing Address - Phone:423-733-2228
Mailing Address - Fax:423-733-2428
Practice Address - Street 1:178 WILLOW ST
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-3666
Practice Address - Country:US
Practice Address - Phone:423-733-2228
Practice Address - Fax:423-733-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3910087Medicare PIN