# EAST TENNESSEE STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mountain City Extended Hours Health Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295779361
- **Authorized official:** BETTY J KING (ACTING CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (423) 439-4414

## Contact information

- **Practice address:** 1901 S SHADY STREET, MOUNTAIN CITY, TN 37683-2601
- **Practice address phone:** (423) 727-1150
- **Practice address fax:** (423) 727-1152
- **Mailing address:** PO BOX 70403, JOHNSON CITY, TN 37614-1703
- **Mailing address phone:** (423) 439-4515
- **Mailing address fax:** (423) 439-5780

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/16/2006
- **Last updated:** 09/22/2017