NPIMap

Organization Active NPI

State of Tennessee

Doing business as Dickson County-White Bluff Clinic

  • Public Health or Welfare Agency
  • White Bluff, TN
National Provider Identifier
1205988144
Registry record updated Aug 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
STATE OF TENNESSEE
Doing business as
Dickson County-White Bluff Clinic
Practice address
200 School Rd
White Bluff, TN 37187-9020
Phone
(615) 797-5056
Fax
(615) 797-5051
NPI assigned
Jan 18, 2007
Last updated
Aug 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Annette Haley
Title
Regional Director
Phone
(615) 650-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X TN Primary

Addresses

Primary practice location

200 School Rd
White Bluff, TN 37187-9020

Mailing address

200 School Rd
White Bluff, TN 37187-9020
Phone (615) 797-5056

Other identifiers 1

IdentifierTypeStateIssuer
3913113MedicaidTN

Other names 1

  • Dickson County-White Bluff Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013001259 TN Part B Supplier - Mass Immunization (Roster Biller Only) 5698687077 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Loudon County Health de202 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

200 School Rd
White Bluff, TN 37187
Phone (615) 797-5056

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346112000000",
    "number": "1205988144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SCHOOL RD",
            "city": "WHITE BLUFF",
            "state": "TN",
            "postal_code": "371879020",
            "telephone_number": "615-797-5056",
            "fax_number": "615-797-5051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SCHOOL RD",
            "city": "WHITE BLUFF",
            "state": "TN",
            "postal_code": "371879020",
            "telephone_number": "615-797-5056",
            "fax_number": "615-797-5051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2012-08-28",
        "status": "A",
        "authorized_official_last_name": "HALEY",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "615-650-7000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3913113",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dickson County-White Bluff Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in White Bluff, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.