Provider Demographics
NPI:1457435893
Name:STATE OF TENNESSEE STATE F & A PAYROLL
Entity Type:Organization
Organization Name:STATE OF TENNESSEE STATE F & A PAYROLL
Other - Org Name:MEMPHIS MENTAL HEALTH INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-228-0869
Mailing Address - Street 1:951 COURT AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2813
Mailing Address - Country:US
Mailing Address - Phone:901-577-1800
Mailing Address - Fax:901-527-1331
Practice Address - Street 1:951 COURT AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2813
Practice Address - Country:US
Practice Address - Phone:901-577-1800
Practice Address - Fax:901-527-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000017094283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN444001Medicaid
TN444001Medicare UPIN
TN17728300Medicaid