Provider Demographics
NPI:1922029743
Name:STATE OF TENNESSEE
Entity Type:Organization
Organization Name:STATE OF TENNESSEE
Other - Org Name:LINCOLN COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-490-8334
Mailing Address - Street 1:1000 WASHINGTON ST W
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2872
Mailing Address - Country:US
Mailing Address - Phone:931-433-3231
Mailing Address - Fax:931-438-1567
Practice Address - Street 1:1000 WASHINGTON ST W
Practice Address - Street 2:SUITE A
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2872
Practice Address - Country:US
Practice Address - Phone:931-433-3231
Practice Address - Fax:931-438-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4448003Medicaid
TN0141402OtherBC/BS & TENNCARE SELECT
TN4794OtherDORAL DENTAL
TN4448003Medicaid