Organization Name: | STATE OF TENNESSEE |
NPI Number: | 1497892343 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JUDY K SHAW (ACCOUNTING TECHNICIAN) |
Mailing Address: | 170 Church St Dunlap |
State: | TN US |
Postal Code: | 373273710 |
Phone Number: | 4239493619 |
Fax Number: | 4239496507 |
NPI Enumeration Date: | 01/31/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251K00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Public Health or Welfare |
Taxonomy Specialization: | |
Taxonomy Definition: |