Provider Demographics
NPI:1801191879
Name:STATE OF TENNESSEE
Entity Type:Organization
Organization Name:STATE OF TENNESSEE
Other - Org Name:N E REGIONAL HEALTH OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLI
Authorized Official - Middle Name:L
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-979-4609
Mailing Address - Street 1:1233 SOUTHWEST AVE EXT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6519
Mailing Address - Country:US
Mailing Address - Phone:423-979-3200
Mailing Address - Fax:423-979-3271
Practice Address - Street 1:1233 SOUTHWEST AVE EXT
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6519
Practice Address - Country:US
Practice Address - Phone:423-979-3200
Practice Address - Fax:423-979-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare