NPIMap

Organization Active NPI

State of Tennessee

Doing business as Coffee County Health Dept. - Tullahoma Clinic

  • Public Health or Welfare Agency
  • Tullahoma, TN
National Provider Identifier
1699795468
Registry record updated Sep 25, 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
Coffee County Health Dept. - Tullahoma Clinic
Practice address
615 Wilson Ave
Tullahoma, TN 37388-3264
Phone
(931) 455-9369
Fax
(931) 455-4827
NPI assigned
Jul 21, 2006
Last updated
Sep 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2012

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

Authorized official

Name
Barbara J Whitwell
Title
Office Supervisor
Phone
(931) 490-8334

Specialties & licenses 1

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

Addresses

Primary practice location

615 Wilson Ave
Tullahoma, TN 37388-3264

Mailing address

615 Wilson Ave
Tullahoma, TN 37388-3264
Phone (931) 455-9369

Other identifiers 2

IdentifierTypeStateIssuer
2002854OtherTNBC/BS & TENNCARE SELECT
4448008MedicaidTN

Other names 1

  • Coffee County Health Dept. - Tullahoma 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
Bristol Health Center202 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

51 Smith Ave
Hohenwald, TN 38462
Phone (931) 796-2204

251 Majors Blvd
Lynchburg, TN 37352
Phone (931) 759-4251

800 Parks St
Manchester, TN 37355
Phone (931) 723-5134

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348531200000",
    "number": "1699795468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 WILSON AVE",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373883264",
            "telephone_number": "931-455-9369",
            "fax_number": "931-455-4827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 WILSON AVE",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373883264",
            "telephone_number": "931-455-9369",
            "fax_number": "931-455-4827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2012-09-25",
        "status": "A",
        "authorized_official_last_name": "WHITWELL",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE SUPERVISOR",
        "authorized_official_telephone_number": "931-490-8334"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS & TENNCARE SELECT",
            "identifier": "2002854",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4448008",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coffee County Health Dept. - Tullahoma Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tullahoma, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.