NORTHEAST TN PUBLIC HEALTH NPI 1013991686

NPI Information

NPI: 1013991686
Provider Name: NORTHEAST TN PUBLIC HEALTH
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

CLIA Number: 44D0918407

Address:
1233 SOUTHWEST AVE EXT
JOHNSON CITY, TN
ZIP 37604
Phone: (423) 979-3200
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NORTHEAST TN PUBLIC HEALTH is a dental clinic center in Johnson City, TN. NORTHEAST TN PUBLIC HEALTH NPI is 1013991686. The provider is registered as an organization entity type.

The provider's business location address is:

1233 SOUTHWEST AVE EXT
JOHNSON CITY, TN
ZIP 37604
Phone: (423) 979-3200
Fax: (423) 979-3267

The provider's authorized official is Rebecca B Vestal .
The authorized official title is Dental Director and has the following contact phone number (423) 979-3200.

The CLIA number assigned to this NPI record is 44D0918407 - public health laboratories with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 12/6/2005 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3209286	MEDICAID	TENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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