Provider Demographics
NPI:1780821801
Name:CHEROKEE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:CHEROKEE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:423-587-7337
Mailing Address - Street 1:6350 W A J HWY
Mailing Address - Street 2:DEPARTMENT 100
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:120 HOSPITAL DR
Practice Address - Street 2:SUITE 230
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5287
Practice Address - Country:US
Practice Address - Phone:865-471-0312
Practice Address - Fax:865-475-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3706725Medicaid
TN44-1909OtherFQHC - MEDICARE
TN44-1909OtherFQHC - MEDICAID
TN3696394Medicaid
TN3686393Medicaid
TN3706725Medicaid
TN3696394Medicare Oscar/Certification
TN44-1909OtherFQHC - MEDICARE