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Contact Information

EAST TENNESSEE STATE UNIVERSITY
1134-1136 E. MAIN STREET
JOHNSON CITY, TN37601
 Phone: 423-722-0808
 Fax: 423-929-2930
 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 # 1982905576
LBN Legal business name EAST TENNESSEE STATE UNIVERSITY
Authorized official BETTY KING - (ACTING CHIEF FINANCIAL OFFICER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/12/2010
Last updated 07/21/2022 - About 4 years ago
Identifiers
TN Medicaid 1522314
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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