Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Public Health or Welfare |
251K00000X | 60 | Public Health or Welfare Agency | |
Federally Qualified Health Center (FQHC) |
261QF0400X | B4[14] | Federally Qualified Health Center |
| NPI Number | 1083767883 |
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| LBN Legal business name | STATE OF TENNESSEE | ||||
| Authorized official | ANNETTE HALEY - (REGIONAL DIRECTOR) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 01/18/2007 | ||||
| Last updated | 08/28/2012 - About 14 years ago | ||||
| Identifiers |
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STATE OF TENNESSEE
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