NPIMap

Organization Active NPI

State of Tennessee

Doing business as Polk County Health Department- Copper Basin

  • Public Health or Welfare Agency
  • Copperhill, TN
National Provider Identifier
1659418598
Registry record updated Feb 8, 2022
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
Polk County Health Department- Copper Basin
Practice address
840 Cherokee TRL
Copperhill, TN 37317-5200
Phone
(423) 496-3275
Fax
(423) 496-4442
NPI assigned
Jan 31, 2007
Last updated
Feb 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2022

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

Authorized official

Name
Mr. Richard W McCarthy
Title
Accounting Manager
Phone
(423) 634-5832

Specialties & licenses 1

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

Addresses

Primary practice location

840 Cherokee TRL
Copperhill, TN 37317-5200

Mailing address

840 Cherokee TRL
Copperhill, TN 37317-5200
Phone (423) 496-3275

Other names 1

  • Polk County Health Department- Copper Basin 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

840 Cherokee Trl
Copperhill, TN 37317
Phone (423) 496-3275

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644278400000",
    "number": "1659418598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 CHEROKEE TRL",
            "city": "COPPERHILL",
            "state": "TN",
            "postal_code": "373175200",
            "telephone_number": "423-496-3275",
            "fax_number": "423-496-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 CHEROKEE TRL",
            "city": "COPPERHILL",
            "state": "TN",
            "postal_code": "373175200",
            "telephone_number": "423-496-3275",
            "fax_number": "423-496-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A",
        "authorized_official_last_name": "MCCARTHY",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ACCOUNTING MANAGER",
        "authorized_official_telephone_number": "423-634-5832",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Polk County Health Department- Copper Basin",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Polk County Health Department- Copper Basin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Copperhill, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; 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.