EAST TENNESSEE STATE UNIVERSITY NPI 1568570273

NPI Information

EAST TENNESSEE STATE UNIVERSITY is a multi-specialty clinic center in Johnson City, TN. EAST TENNESSEE STATE UNIVERSITY NPI is 1568570273. The provider is registered as an organization entity type.
The provider Is Doing Business As Student University Health Services.

The provider's business location address is:

365 STOUT DRIVE
NICKS HALL RM 160
JOHNSON CITY, TN
ZIP 37614-500
Phone: (423) 439-4225
Fax: (423) 439-4560

The provider's authorized official is Betty J King .
The authorized official title is Acting Chief Financial Officer and has the following contact phone number (423) 439-4414.

The CLIA number assigned to this NPI record is 44D0862277 - school/student health service with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/25/2006 and was last updated on 9/22/2017.

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:

Other Identifiers

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

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