1134110042 NPI number — COUNTY OF GRAINGER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134110042 NPI number — COUNTY OF GRAINGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF GRAINGER
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:
6
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:
1134110042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 863
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27023-0863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-766-4448
Provider Business Mailing Address Fax Number:
336-766-1279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 JUSTICE CENTER DRIVE,
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RUTLEDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-828-3682
Provider Business Practice Location Address Fax Number:
865-828-3713
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCDANIEL
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
865-828-3682

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  2901 , 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: 000043400 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000043400 . This is a "TENNCARE & TENNCARE SELEC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000043400 . This is a "BLUE CROSS 65" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 702004413 . This is a "CARITEN & CARITEN SENIOR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3547821 . This is a "TENNCARE BUREAU" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3547821 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590002706 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7102000TN3786 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000043400 . This is a "BCBS MEMBERS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000043400 . This is a "BCBS TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100022008 . This is a "PHP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 912926000 . This is a "FLORIDA MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000043400 . This is a "BLUECARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000043400 . This is a "BLUE NETWORK" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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