1023346152 NPI number — TENNESSEE COMMUNITY SERVICES AGENCY

Table of content: (NPI 1023346152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023346152 NPI number — TENNESSEE COMMUNITY SERVICES AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENNESSEE COMMUNITY SERVICES AGENCY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023346152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 368
Provider Second Line Business Mailing Address:
1604 WEST REELFOOT AVENUE
Provider Business Mailing Address City Name:
UNION CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38281-0368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-884-2640
Provider Business Mailing Address Fax Number:
731-884-2644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
531 METROPLEX DR
Provider Second Line Business Practice Location Address:
STE 115 A
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37211-3169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-333-5400
Provider Business Practice Location Address Fax Number:
615-620-0053
Provider Enumeration Date:
12/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MCWHERTER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
D
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
731-884-2640

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  10000000004559 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H445-085 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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