Provider Demographics
NPI:1942355722
Name:STATE OF TENNESSEE
Entity Type:Organization
Organization Name:STATE OF TENNESSEE
Other - Org Name:JOHNSON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-727-9731
Mailing Address - Street 1:715 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683-1217
Mailing Address - Country:US
Mailing Address - Phone:423-727-9731
Mailing Address - Fax:423-727-4153
Practice Address - Street 1:715 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-1217
Practice Address - Country:US
Practice Address - Phone:423-727-9731
Practice Address - Fax:423-727-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G739377Medicare PIN