EAST TENNESSEE STATE UNIVERSITY (NPI# 1295779361) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295779361 |
| Entity Type | Organization |
| Organization Name | EAST TENNESSEE STATE UNIVERSITY |
| Other Organization Name | MOUNTAIN CITY EXTENDED HOURS HEALTH CENTER |
| Practice Address |
1901 S Shady Street Mountain City TN 37683-2601 |
| Mailing Address |
Po Box 70403 Johnson City TN 37614-1703 |
| Practice Telephone | 4237271150 |
| Practice Fax Number | 4237271152 |
| Mailing Telephone | 4234394515 |
| Mailing Fax Number | 4234395780 |
| Enumeration Date | 2006-06-16 |
| 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 | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Mountain City Extended Hours Health 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 |
| 1093990608 | East Tennessee State University | Clinic/Center | 202 W Fairview Ave, Johnson City, TN 37604-5611 | 2008-01-02 |
| 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 |
| 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 |
1901 S SHADY STREET |
| City | MOUNTAIN CITY |
| State | TN |
| Zip Code | 37683-2601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578819439 | Deborah J Hassebrock | Nurse Practitioner | 1901 S Shady Street, Mountain City, TN 37683-2021 | 2012-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245749126 | Sugaree Ganzman | Registered Nurse | 277 Trout Run Rd, Mountain City, TN 37683 | 2017-09-24 |
| 1013390764 | Emily B. Mcqueen | Nurse Practitioner | 1901 South Shady Street, Mountain City, TN 37683 | 2015-06-30 |
| 1972917755 | Kelly Horne Singleton | Nurse Practitioner | 3916 Hwy 421 South, Mountain City, TN 37683 | 2014-06-19 |
| 1548496557 | Michelle Wilson | Nurse Practitioner | 1901 S. Shady Street, Mountain City, TN 37683 | 2009-06-04 |
| 1710025069 | Sheila Annette Porter | Counselor | 318 Donnelly Street, Mtn City, TN 37683 | 2007-02-01 |
| 1619050390 | Brandy Lynn Bennett | Case Manager/Care Coordinator | 318 Donnelley Street, Johnson Co Counsel Cent, Mtn City, TN 37683 | 2006-10-24 |
| 1811086317 | Robb R Miller | Counselor | 318 Donnelley St, Johnson County Counseling Center, Mountain City, TN 37683 | 2006-10-12 |
| 1700834678 | Margaret Grace Steward | Pharmacist | 1641 South Shady St, Mountain City, TN 37683 | 2006-05-04 |
| 1184169658 | Wanda Jarrett | Nurse Practitioner | 1901 S Shady St, Mountain City, TN 37683 | 2016-12-20 |
| 1558797399 | Mollie E Tolan | Nurse Practitioner | 1901 S. Shady Street, Johnson City, TN 37683 | 2013-09-25 |
| Find all providers in zip 37683 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518079532 | Mountain States Health Alliance | Clinic/Center | 1901 S Shady St, Mountain City, TN 37683-2021 | 2006-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588275317 | Henry County Medical Center | Clinic/Center | 300 Hospital Cir Ste 204, Paris, TN 38242-4597 | 2020-08-14 |
| 1447861562 | Henry County Medical Center | Clinic/Center | 14201 Highway 79 N Unit 4, Buchanan, TN 38222-4183 | 2020-08-12 |
| 1003425224 | Dickson Medical Associate, PC | Clinic/Center | 127 Crestview Park Dr Ste 205, Dickson, TN 37055-2856 | 2020-07-23 |
| 1023631454 | Spring City Family Clinic Pllc | Clinic/Center | 126 Lavender St Ste 2, Spring City, TN 37381-5102 | 2020-05-20 |
| 1871001271 | Shelbyville Hospital Company LLC | Clinic/Center | 1330 Cedar Ln Ste 100, Tullahoma, TN 37388-2284 | 2018-01-19 |
| 1720596125 | Shelbyville Hospital Company LLC | Clinic/Center | 1440 Cedar Ln Unit 100, Tullahoma, TN 37388-2262 | 2018-01-19 |
| 1548788458 | Shelbyville Hospital Company LLC | Clinic/Center | 1612 N Main St Ste A, Shelbyville, TN 37160-2392 | 2017-08-31 |
| 1063938520 | Mid-south Convenient Care, Pllc | Clinic/Center | 1445 Us Highway 51 Byp E Ste B, Dyersburg, TN 38024-2127 | 2017-08-16 |
| 1871034462 | Martin Health | Clinic/Center | 143 Kennedy Drive, Martin, TN 38237-3309 | 2017-03-15 |
| 1881135895 | Humboldt Family Walk-in Clinic LLC | Clinic/Center | 1600 Coleman Dr, Humboldt, TN 38343-1756 | 2017-03-10 |
| Find all providers with the same taxonomy | ||||
| City | MOUNTAIN CITY |
| Zip Code | 37683 |
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.