NPIMap

Organization Active NPI

State of Tennessee

Doing business as Campbell County Health Department

  • Public Health or Welfare Agency
  • Jacksboro, TN
National Provider Identifier
1962540880
Registry record updated Aug 23, 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
Campbell County Health Department
Practice address
162 Sharp Perkins Road
Jacksboro, TN 37757
Phone
(423) 562-8351
Fax
(423) 562-1593
NPI assigned
Feb 2, 2007
Last updated
Aug 23, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2010

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

Authorized official

Name
Marianne F Sharp
Title
Regional Accountant
Phone
(865) 549-5266

Specialties & licenses 1

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

Addresses

Primary practice location

162 Sharp Perkins Road
Jacksboro, TN 37757

Mailing address

PO Box 59019
Knoxville, TN 37950-9019
Phone (423) 562-8351

Other identifiers 2

IdentifierTypeStateIssuer
154308OtherTNBLUECROSS BLUESHIELD TN
4447836MedicaidTN

Other names 1

  • Campbell County Health Department 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
Maury Co Healt H Dept202 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282521600000",
    "number": "1962540880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 59019",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379509019",
            "telephone_number": "423-562-8351",
            "fax_number": "423-562-1593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 SHARP PERKINS ROAD",
            "city": "JACKSBORO",
            "state": "TN",
            "postal_code": "37757",
            "telephone_number": "423-562-8351",
            "fax_number": "423-562-1593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2010-08-23",
        "status": "A",
        "authorized_official_last_name": "SHARP",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "REGIONAL ACCOUNTANT",
        "authorized_official_telephone_number": "865-549-5266"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD TN",
            "identifier": "154308",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4447836",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Campbell County Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksboro, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.