Provider Demographics
NPI:1770588683
Name:GRUNDY COUNTY HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:GRUNDY COUNTY HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER- PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:BREA
Authorized Official - Last Name:LANGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:931-592-4242
Mailing Address - Street 1:740 MAIN ST
Mailing Address - Street 2:PO BOX 1449
Mailing Address - City:TRACY CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37387-1449
Mailing Address - Country:US
Mailing Address - Phone:931-592-4242
Mailing Address - Fax:931-592-4245
Practice Address - Street 1:740 MAIN ST
Practice Address - Street 2:
Practice Address - City:TRACY CITY
Practice Address - State:TN
Practice Address - Zip Code:37387-4020
Practice Address - Country:US
Practice Address - Phone:931-592-4242
Practice Address - Fax:931-592-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ065726Medicaid
TN1750962528OtherNPI