NPIMap

Organization Active NPI

State of Tennessee

Doing business as Gibson County Health Department Humboldt Clinic

  • Public Health or Welfare Agency
  • Humboldt, TN
National Provider Identifier
1821148081
Registry record updated Aug 25, 2010
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
Gibson County Health Department Humboldt Clinic
Practice address
149 North 12TH Street
Humboldt, TN 38343
Phone
(731) 784-5491
Fax
(731) 784-1726
NPI assigned
Jan 11, 2007
Last updated
Aug 25, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2010

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

Authorized official

Name
Mrs. Marilyn Barnes
Title
Regional Director
Phone
(731) 421-6700

Specialties & licenses 1

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

Addresses

Primary practice location

149 North 12TH Street
Humboldt, TN 38343

Mailing address

149 North 12TH Street
Humboldt, TN 38343
Phone (731) 784-5491

Other identifiers 1

IdentifierTypeStateIssuer
4448184MedicaidTN

Other names 1

  • Gibson County Health Department Humboldt 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

10825 Old Highway 64
Bolivar, TN 38008
Phone (731) 658-5291

710 James Robertson Pkwy
Fl 7
Nashville, TN 37219

Practitioners & affiliated clinicians

Practitioners 1

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": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282694400000",
    "number": "1821148081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 NORTH 12TH STREET",
            "city": "HUMBOLDT",
            "state": "TN",
            "postal_code": "38343",
            "telephone_number": "731-784-5491",
            "fax_number": "731-784-1726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 NORTH 12TH STREET",
            "city": "HUMBOLDT",
            "state": "TN",
            "postal_code": "38343",
            "telephone_number": "731-784-5491",
            "fax_number": "731-784-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2010-08-25",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "731-421-6700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4448184",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gibson County Health Department Humboldt Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Humboldt, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2010; 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.