1134110042 NPI number — COUNTY OF GRAINGER

Table of content: (NPI 1134110042)

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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