State of Tennessee

Primary specialty

Public Health or Welfare AgencyTaxonomy code 251K00000X

Legal business name

STATE OF TENNESSEE

Practice address

251 Majors Blvd
Lynchburg, TN 37352-8352

Phone

(931) 759-4251

Fax

(931) 759-6380

NPI assigned

Jul 21, 2006

Organization subpart

No

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

Addresses

Other identifiers 3

Other names 1

• Metro Moore Health Facility Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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": "1912928664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 MAJORS BLVD",
            "city": "LYNCHBURG",
            "state": "TN",
            "postal_code": "373528352",
            "telephone_number": "931-759-4251",
            "fax_number": "931-759-6380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 MAJORS BLVD",
            "city": "LYNCHBURG",
            "state": "TN",
            "postal_code": "373528352",
            "telephone_number": "931-759-4251",
            "fax_number": "931-759-6380"
        }
    ],
    "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": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4448000",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS & TENNCARE SELECT",
            "identifier": "0119549",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNCARE SELECT PCP",
            "identifier": "3065987",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Metro Moore Health Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deadra Renea Quinn, APN
• Robert R Yasui
• Robert W Gray
• Shelbyville Hospital Corporation
• Penelope A. Smith, M.A.
• Jana M. Stovall, NP
• Univita of Tennessee, Inc.
• Cathleen Marie Vaughan, M.S.S.W.
• Robert R Yasui, PA-C

• All providers in Lynchburg, TN
• Public Health or Welfare Agency in Tennessee

• 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.