State of Tennessee
Organization Active NPI Public Health or Welfare Agency · Johnson City, TN
NPI 1447397666 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1447397666
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Public Health or Welfare Agency 251K00000X
- Legal business name
- STATE OF TENNESSEE
- Practice address
- 219 Princeton Rd
Johnson City, TN 37601-2062 - Phone
- (423) 979-4609
- Fax
- (423) 979-3271
- NPI assigned
- Jan 30, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. James Timothy Carson, MSEH
- Title
- County Director 3
- Phone
- (423) 975-7927
Corporate family (same tax ID) 24
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041013001259 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 5698687077 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Trousdale County Health
Locations
415 State of Franklin Rd
Johnson City, TN 37604
Phone (423) 975-2200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | TN | Yes |
Addresses
Primary practice location
219 Princeton Rd
Johnson City, TN 37601-2062
Mailing address
219 Princeton Rd
Johnson City, TN 37601-2062
Phone (423) 975-2200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 444-7994 | Medicaid | TN |
Other names
- Washington County Health Department
Other providers in Johnson City, TN
- Janet Florence Stastny
- State of Franklin Healthcare Associates PLLC
- State of Franklin Healthcare Associates PLLC
- State of Tennessee
- State of Tennessee
- State of Tennessee
- State of Tennessee
- Aaron Stavrakis
- Alexandra M Steadman-Cowan
- Christine Steadman
All providers in Johnson City, TN · Public Health or Welfare Agency in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.