Provider Demographics
NPI:1265570600
Name:TENNESEE DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:TENNESEE DEPARTMENT OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:423-634-5832
Mailing Address - Street 1:1301 RIVERFRONT PKWY STE 209
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-3312
Mailing Address - Country:US
Mailing Address - Phone:423-634-5832
Mailing Address - Fax:423-634-3186
Practice Address - Street 1:1501 RIVERSIDE DR STE 120
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-4332
Practice Address - Country:US
Practice Address - Phone:423-634-3110
Practice Address - Fax:423-634-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4447818Medicaid