EAST TENNESSEE STATE UNIVERSITY (NPI# 1568570273) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568570273 |
| Entity Type | Organization |
| Organization Name | EAST TENNESSEE STATE UNIVERSITY |
| Other Organization Name | STUDENT UNIVERSITY HEALTH SERVICES |
| Practice Address |
365 Stout Drive Nicks Hall Rm 160 Johnson City TN 37614-6500 |
| Mailing Address |
365 Stout Drive Box 70403 Johnson City TN 37614-1703 |
| Practice Telephone | 4234394225 |
| Practice Fax Number | 4234394560 |
| Mailing Telephone | 4234394515 |
| Mailing Fax Number | 4234395780 |
| Enumeration Date | 2006-08-25 |
| 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 |
|---|---|---|---|---|---|
| N | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3709292 | 05 |
| Other Name | Type Code |
|---|---|
| Student University Health Services | 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 |
| 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 |
365 STOUT DRIVE NICKS HALL RM 160 |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37614-6500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639696784 | Talisha Ettina Leeann Troutt | Nurse Practitioner | 365 Stout Drive, Suite 160, Johnson City, TN 37614-3761 | 2017-08-29 |
| 1558806745 | Meira Yasin | Nurse Practitioner | 365 Stout Drive, Suite 160, Johnson City, TN 37614-1703 | 2016-12-27 |
| 1760883680 | Retha D Gentry | Nurse Practitioner | 365 Stout Drive, Nicks Hall Room 160, Johnson City, TN 37614-7114 | 2014-09-10 |
| 1679889356 | Amanda S Moorhouse | Nurse Practitioner | 365 Stout Drive, Johnson City, TN 37614-1703 | 2010-08-19 |
| 1487892220 | Donna C. Fraysier | Clinical Nurse Specialist | 365 Stout Drive, Nicks Hall, Room 160, Johnson City, TN 37614 | 2009-02-02 |
| 1083750590 | Stanley Lee Ridner IIi | Nurse Practitioner | 365 Stout Drive, Suite 160, Johnson City, TN 37614 | 2007-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467061887 | Jessica Marie Robinson | Pharmacist | Maple Avenue Building 7, Johnson City, TN 37614 | 2020-07-31 |
| 1881220697 | Rachel Miller Slough | Psychologist | 801 S Dossett Drive, Johnson City, TN 37614 | 2020-03-13 |
| 1326682493 | Yoshihiro Kojima | Specialist/Technologist | 127 W John Robert Bill Dr, Johnson City, TN 37614 | 2019-11-01 |
| 1205360104 | Charlotte Lynn Alexander | Student in an Organized Health Care Education/Training Program | Department of Obstetrics and Gynecology, 70569, Qcom Building 1, Room 307, Johnson City, TN 37614 | 2017-04-18 |
| 1679006787 | Joel Whipple | Student in an Organized Health Care Education/Training Program | Etsu - Building 1, 2nd Floor, Johnson City, TN 37614 | 2017-04-05 |
| 1497295711 | Charles Faust | Dental Hygienist | 1276 Gilbreath Dr, Johnson City, TN 37614 | 2017-03-06 |
| 1265889414 | Dyan Darang | Student in an Organized Health Care Education/Training Program | Etsu, Quillen College of Medicine, Psychiatry Residency Program, Box 70567, Johnson City, TN 37614 | 2016-05-18 |
| 1194170142 | Katharine Ann Lasher | Student in an Organized Health Care Education/Training Program | Dept. of Surgery, Dogwood Ave, Building 1, Rm 249, East Tennessee State Univ. Quillen College of Medicine, Johnson City, TN 37614 | 2016-04-27 |
| 1992150189 | Nishika Shina Moradia | Student in an Organized Health Care Education/Training Program | East Tennessee State University Quillen College of Medi, Dogwood Ave, Building 1, Room 249, Johnson City, TN 37614 | 2016-04-26 |
| 1962884429 | Apurva Bansal | Student in an Organized Health Care Education/Training Program | 325 North State of Franklin, Johnson City, TN 37614 | 2015-06-22 |
| Find all providers in zip 37614 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962463851 | United Health Services Hospitals, Inc. | Clinic/Center | 33-57 Harrison St., Johnson City, NY 13790 | 2006-03-30 |
| 1437335312 | United Cerebral Palsy Assoc of Nys Inc | Clinic/Center | 18 Broad St, Johnson City, NY 13790-2106 | 2008-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124635594 | Bryn Medical Pllc | Clinic/Center | 4295 Cromwell Rd Ste 301, Chattanooga, TN 37421-2163 | 2020-09-29 |
| 1952914285 | Methodist Physician Practice LLC | Clinic/Center | 1211 Union Ave Ste 330, Memphis, TN 38104-6655 | 2020-08-26 |
| 1831721208 | Patientchoicemd, LLC | Clinic/Center | 3274 Wind Shadow Cv, Memphis, TN 38125-0773 | 2020-02-04 |
| 1518515733 | Chs Tennessee Medical P C | Clinic/Center | 800 Howard Baker Ave # Jr, Knoxville, TN 37915-2509 | 2019-08-30 |
| 1245898303 | Summit Medical Group, Pllc | Clinic/Center | 7545 Barnett Way Ste A, Powell, TN 37849-3565 | 2019-06-04 |
| 1992362412 | The Restore Clinic | Clinic/Center | 268 Veterans Pkwy Ste F, Murfreesboro, TN 37128-6432 | 2019-05-20 |
| 1316427602 | Chs Tennessee Medical P C | Clinic/Center | 2680 Pershing Ave, Memphis, TN 38112 | 2018-08-16 |
| 1720565906 | Woodland Medical Pllc | Clinic/Center | 6221 Shallowford Rd Ste 100, Chattanooga, TN 37421-1972 | 2018-07-20 |
| 1861981797 | Chs Tennessee Medical P C | Clinic/Center | 2782 York Rd, Pleasant View, TN 37146-9070 | 2018-05-07 |
| 1316436611 | Lourdes Physician Services LLC | Clinic/Center | 103 Continental Pl Ste 200, Brentwood, TN 37027-1042 | 2018-05-02 |
| Find all providers with the same taxonomy | ||||
| City | JOHNSON CITY |
| Zip Code | 37614 |
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.