NPIMap

Organization Active NPI

East Tennessee State University

Doing business as Mountain City Extended Hours Health Center

  • Rural Health Clinic/Center
  • Mountain City, TN
National Provider Identifier
1295779361
Registry record updated Sep 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EAST TENNESSEE STATE UNIVERSITY
Doing business as
Mountain City Extended Hours Health Center
Practice address
1901 S Shady Street
Mountain City, TN 37683-2601
Phone
(423) 727-1150
Fax
(423) 727-1152
NPI assigned
Jun 16, 2006
Last updated
Sep 22, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2017

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

Authorized official

Name
Betty J King
Title
Acting Chief Financial Officer
Phone
(423) 439-4414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1901 S Shady Street
Mountain City, TN 37683-2601

Mailing address

PO Box 70403
Johnson City, TN 37614-1703
Phone (423) 439-4515

Other names 1

  • Mountain City Extended Hours Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031212000403 TN Part B Supplier - Clinic/Group Practice 2769394774 Receives reassigned benefits from 44 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Johnson City, TN; Sneedville, TN

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Etsu Behavioral Health and Wellness Clinic20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506038400000",
    "number": "1295779361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70403",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376141703",
            "telephone_number": "423-439-4515",
            "fax_number": "423-439-5780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S SHADY STREET",
            "city": "MOUNTAIN CITY",
            "state": "TN",
            "postal_code": "376832601",
            "telephone_number": "423-727-1150",
            "fax_number": "423-727-1152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2017-09-22",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ACTING CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "423-439-4414"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain City Extended Hours Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2017; 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.