Organization Active NPI

State of Tennessee

  • State or Local Public Health Clinic/Center
  • Rockwood, TN
National Provider Identifier
1437203809
Registry record updated Nov 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
Legal business name
STATE OF TENNESSEE
Practice address
1362 N Gateway Ave
Rockwood, TN 37854-4108
Phone
(865) 354-1220
Fax
(865) 354-0112
NPI assigned
Jan 23, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Marianne F Sharp
Title
Regional Accountant
Phone
(865) 549-5266

Corporate family (same tax ID) 24

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

View all 24

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
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
Trousdale County Health (202 organizations share this tax ID)

Locations

1362 N Gateway Ave
Rockwood, TN 37854
Phone (865) 354-1220

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
State or Local Public Health Clinic/Center 261QP0905X Primary

Addresses

NPPES NPI Registry

Primary practice location

1362 N Gateway Ave
Rockwood, TN 37854-4108

Mailing address

PO Box 59019
Knoxville, TN 37950-9019
Phone (865) 549-5266

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
2008151OtherTNBLUECROSS BLUESHIELD
4447825MedicaidTN

Other names 1

NPPES NPI Registry
  • Roane County Health Department Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 16, 2009.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258329600000",
    "number": "1437203809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 59019",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379509019",
            "telephone_number": "865-549-5266",
            "fax_number": "865-594-8919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1362 N GATEWAY AVE",
            "city": "ROCKWOOD",
            "state": "TN",
            "postal_code": "378544108",
            "telephone_number": "865-354-1220",
            "fax_number": "865-354-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2009-11-16",
        "status": "A",
        "authorized_official_last_name": "SHARP",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "REGIONAL ACCOUNTANT",
        "authorized_official_telephone_number": "865-549-5266"
    },
    "taxonomies": [
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "2008151",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4447825",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roane County Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockwood, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2009; 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.