EAST TENNESSEE STATE UNIVERSITY (NPI# 1093990608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093990608 |
| Entity Type | Organization |
| Organization Name | EAST TENNESSEE STATE UNIVERSITY |
| Other Organization Name | JOHNSON CITY DOWNTOWN CLINIC DAY CENTER |
| Practice Address |
202 W Fairview Ave Johnson City TN 37604-5611 |
| Mailing Address |
365 Stout Drive Box 70403 Johnson City TN 37614-1703 |
| Practice Telephone | 4234340894 |
| Practice Fax Number | 4234340666 |
| Mailing Telephone | (423) 439-4515 |
| Mailing Fax Number | 4234395780 |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2017-09-22 |
| Authorized Official Name | BETTY J. KING (ACTING CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 4234394414 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Johnson City Downtown Clinic Day Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275902884 | East Tennessee State University | Nurse Practitioner | 1000 N Roan St, Johnson City, TN 37601-4616 | 2015-09-24 |
| 1952785081 | East Tennessee State University | Nurse Practitioner | 3261 Tn 81, Jonesborough, TN 37659 | 2015-07-18 |
| 1982905576 | East Tennessee State University | Clinic/Center | 1134-1136 E. Main Street, Johnson City, TN 37601 | 2010-11-12 |
| 1851526826 | East Tennessee State University | Nurse Practitioner | 306 Forrest Dr, Jonesborough, TN 37659-1550 | 2009-05-20 |
| 1548422330 | East Tennessee State University | Audiologist | 837 Pardee St, Johnson City, TN 37601-5900 | 2008-07-02 |
| 1942474762 | East Tennessee State University | Speech-Language Pathologist | 300 Urbana Rd, Limestone, TN 37681-2824 | 2008-04-14 |
| 1326142563 | East Tennessee State University | Nurse Practitioner | 391 Court Sq, Sneedville, TN 37869-0723 | 2006-09-08 |
| 1568570273 | East Tennessee State University | Nurse Practitioner | 365 Stout Drive, Nicks Hall Rm 160, Johnson City, TN 37614-6500 | 2006-08-25 |
| 1215045976 | East Tennessee State University | Nurse Practitioner | 2700 Main Street, Sneedville, TN 37869-0723 | 2006-08-25 |
| 1295779361 | East Tennessee State University | Clinic/Center | 1901 S Shady Street, Mountain City, TN 37683-2601 | 2006-06-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | EAST TENNESSEE STATE UNIVERSITY | 2109 W Market St, Johnson City, TN 37604-6024 |
| Street Address |
202 W FAIRVIEW AVE |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-5611 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396363420 | Judith Wangari Gichia-waldrop | Registered Nurse | 202 W Fairview Ave, Johnson City, TN 37604-5611 | 2020-07-06 |
| 1720550288 | Jennifer Lyn Whitehead | Social Worker | 202 W Fairview Ave, Johnson City, TN 37604-5611 | 2018-12-21 |
| 1275050627 | Leslie Bodo | Nurse Practitioner | 202 W Fairview Ave, Johnson City, TN 37604-5611 | 2017-08-26 |
| 1699921981 | Janice Lynn Lazear | Nurse Practitioner | 202 W Fairview Ave, Johnson City, TN 37604-5611 | 2008-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560707 | Brant Logan Nickens | Physical Therapist | 809 Lamont St and Veterans Way, Johnson City, TN 37604 | 2020-08-26 |
| 1952911562 | David Sandlin Hobbs | Pharmacist | Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 | 2020-08-07 |
| 1528688272 | Whitney Marie Ward | Physical Therapist | Lamont Street and Veterans Way, Johnson City, TN 37604 | 2020-04-23 |
| 1861050015 | Akesh Thomas | Student in an Organized Health Care Education/Training Program | Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 | 2019-06-03 |
| 1336629021 | Medical Education Assistance Corporation | Clinic/Center | 820 W Market St, Johnson City, TN 37604 | 2018-08-21 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1174014450 | Jerica Moore | Specialist/Technologist | 1041 Hamiltion Place Dr., Johnson City, TN 37604 | 2018-05-23 |
| 1053809442 | Syed Ghazanfar Hasan | Student in an Organized Health Care Education/Training Program | Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 | 2018-05-01 |
| 1699262485 | Sonia Kumari Oad | Student in an Organized Health Care Education/Training Program | 178 West Maple St, Johnson City, TN 37604 | 2018-04-17 |
| 1821519364 | Mahmoud El Iskandarani | Internal Medicine | 1084 W Oakland Avenue, 748, Johnson City, TN 37604 | 2017-07-06 |
| Find all providers in zip 37604 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982905576 | East Tennessee State University | Clinic/Center | 1134-1136 E. Main Street, Johnson City, TN 37601 | 2010-11-12 |
| 1477660199 | East Tennessee State University | Clinic/Center | 2151 Century Lane, Johnson City, TN 37604 | 2006-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912525809 | Christ Community Health Services, Inc | Clinic/Center | 4350 Chuck Ave, Memphis, TN 38118-4076 | 2020-07-08 |
| 1730707621 | Christ Community Health Services, Inc. | Clinic/Center | 3206 Poplar Ave, Memphis, TN 38111-3502 | 2020-07-08 |
| 1003442112 | Christ Commuity Health Services Inc | Clinic/Center | 3360 S 3rd St, Memphis, TN 38109-2944 | 2020-03-20 |
| 1689160939 | Maury Regional Hospital | Clinic/Center | 98 Experiment Station Lane, Columbia, TN 38401-4700 | 2018-07-10 |
| 1194245399 | United Neighborhood Health Services, Inc. | Clinic/Center | 442 Metroplex Dr Ste 200, Nashville, TN 37211-3112 | 2017-06-20 |
| 1659745354 | Memphis Health Center, Inc. | Clinic/Center | 4250 Faronia Rd Ste 2a, Memphis, TN 38116-6527 | 2015-11-18 |
| 1639546187 | United Neighborhood Health Services, Inc. | Clinic/Center | 3904 Gallatin Pike, Nashville, TN 37216 | 2015-08-31 |
| 1790170389 | Maury Regional Hospital | Clinic/Center | 854 W James M Campbell Blvd Ste 301, Columbia, TN 38401-4659 | 2015-04-01 |
| 1285999128 | United Neighborhood Health Services, Inc | Clinic/Center | 401 Walton Ln, Nashville, TN 37216-1018 | 2012-07-06 |
| 1891058848 | United Neighborhood Health Services, Inc | Clinic/Center | 1900 Hobson Pike, Antioch, TN 37013-2421 | 2012-06-23 |
| Find all providers with the same taxonomy | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
Please comment or provide details below to improve the information on EAST TENNESSEE STATE UNIVERSITY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.