EAST TENNESSEE STATE UNIVERSITY; NPI #1215045976

Contact Information

EAST TENNESSEE STATE UNIVERSITY

2700 MAIN STREET
SNEEDVILLE, TN 37869-0723

Phone: 423-733-2819
Fax: 423-733-8509
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Federally Qualified Health Center (FQHC)	261QF0400X	B4[14]	Federally Qualified Health Center
Primary Care	363LP2300X	50	Nurse Practitioner

Indicates primary specialty

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NPI Profile & details for EAST TENNESSEE STATE UNIVERSITY

NPI # 1215045976

LBN Legal business name EAST TENNESSEE STATE UNIVERSITY

Authorized official DAVID COLLINS - (CFO, VP FINANCE & ADMINISTRATION)

Entity Organization

Organization subpart ¹ No

Enumeration date 08/25/2006

Last updated 07/21/2022 - About 4 years ago

Identifiers

Medicaid

3709292

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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