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Contact Information

EAST TENNESSEE STATE UNIVERSITY
2151 CENTURY LANE
JOHNSON CITY, TN37604
 Phone: 423-926-2500
 Fax: 423-926-5999
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Federally Qualified Health Center (FQHC)

261QF0400X B4[14] Federally Qualified Health Center
Indicates primary specialty

NPI Profile & details for EAST TENNESSEE STATE UNIVERSITY

NPI # 1477660199
LBN Legal business name EAST TENNESSEE STATE UNIVERSITY
Authorized official BETTY KING - (SENIOR ASSOCIATE VICE PRESIDENT F&A)
Entity Organization
Organization subpart 1 No
Enumeration date 08/25/2006
Last updated 07/21/2022 - About 4 years ago
Identifiers
TN Medicaid 0441901
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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