1578840138 NPI number — COMMUNITY HEALTH OF EAST TENNESSEE, INC

Table of content: DR. JOSEPH J OLIVER MD (NPI 1477564656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578840138 NPI number — COMMUNITY HEALTH OF EAST TENNESSEE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH OF EAST TENNESSEE, INC
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:
DEVELOPMENTAL CENTER
Provider Other Organization Name Type Code:
5
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:
1578840138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37757-0209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-563-1037
Provider Business Mailing Address Fax Number:
423-566-5106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
470 STONE MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37757-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-562-1156
Provider Business Practice Location Address Fax Number:
423-566-5106
Provider Enumeration Date:
11/10/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DABNEY
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
423-562-1705

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  I000000009684 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , with the licence number: I000000009684 , 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: 380 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: PSS0000000260 . This is a "TENNESSEE DEPARTMENT OF HEALTJ" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: I000000009684 . This is a "TENNESSEE DEPARTMENT OF MENTAL HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".