NPIMap

Organization Active NPI

East Tennessee State University

Doing business as ETSU High Risk Clinic

  • Audiologist
  • Johnson City, TN
National Provider Identifier
1861666562
Registry record updated Sep 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Legal business name
EAST TENNESSEE STATE UNIVERSITY
Doing business as
ETSU High Risk Clinic
Practice address
325 N State of Franklin Rd
(Ground Floor With Pediatrics)
Johnson City, TN 37604-6062
Phone
(423) 439-4355
Fax
(423) 439-4607
NPI assigned
Apr 15, 2008
Last updated
Sep 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2008

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

Authorized official

Name
David D. Collins
Title
Cfo, VP Finance & Administration
Phone
(423) 439-5884

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X NU Primary
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

325 N State of Franklin Rd
(Ground Floor With Pediatrics)
Johnson City, TN 37604-6062

Mailing address

PO Box 70403
Johnson City, TN 37614-1703
Phone (423) 439-4078

Other names 1

  • ETSU High Risk Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031212000403 TN Part B Supplier - Clinic/Group Practice 2769394774 Receives reassigned benefits from 44 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Johnson City, TN; Sneedville, TN

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Etsu Behavioral Health and Wellness Clinic20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Locations

325 N State of Franklin Rd
Fl With
Johnson City, TN 37604

NPI Registry JSON

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

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221091200000",
    "number": "1861666562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70403",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376141703",
            "telephone_number": "423-439-4078",
            "fax_number": "423-439-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N STATE OF FRANKLIN RD",
            "address_2": "(GROUND FLOOR WITH PEDIATRICS)",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046062",
            "telephone_number": "423-439-4355",
            "fax_number": "423-439-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-15",
        "last_updated": "2008-09-11",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CFO, VP FINANCE & ADMINISTRATION",
        "authorized_official_telephone_number": "423-439-5884"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETSU High Risk Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; 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.