Provider Demographics
NPI:1790760767
Name:WARREN COUNTY TTEE
Entity Type:Organization
Organization Name:WARREN COUNTY TTEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-473-6902
Mailing Address - Street 1:103 MAGNESS DR
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1321
Mailing Address - Country:US
Mailing Address - Phone:931-473-6902
Mailing Address - Fax:931-473-8473
Practice Address - Street 1:103 MAGNESS DR
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1321
Practice Address - Country:US
Practice Address - Phone:931-473-6902
Practice Address - Fax:931-473-8473
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WARREN COUNTY TTEE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-13
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS0000008901341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3554384Medicaid
80473OtherTENCARE SELECT BLUE CROSS
TN3554384Medicare ID - Type Unspecified