Provider Demographics
NPI:1689862286
Name:STATE OF TENNESSEE
Entity Type:Organization
Organization Name:STATE OF TENNESSEE
Other - Org Name:TENNESSEE DEPARTMENT OF HEALTH, LABORATORY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING AND OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLI
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-307-2330
Mailing Address - Street 1:630 HART LANE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37243
Mailing Address - Country:US
Mailing Address - Phone:615-262-6300
Mailing Address - Fax:615-262-6393
Practice Address - Street 1:630 HART LANE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37243-0001
Practice Address - Country:US
Practice Address - Phone:615-262-6300
Practice Address - Fax:615-262-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002285291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
44D0659062OtherCMS - CLIA
TN0000002285OtherTN STATE LICENSURE