Organization
FRONTIER HEALTH
Active
Other names
Fairview Associates of Johnson City
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA M KIDD PHD (PRESIDENT AND CEO)
(423) 467-3600
Entity
Organization
Contact information
Practice address
607 BAXTER ST, JOHNSON CITY, TN 37601-4003
(423) 232-2670
(423) 928-0381
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
L-214-076-1412
TN
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
L-214-076-1412
TN
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
319
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49-4914-5
—
VA
05
—
SAME AS MEDICARE #S
—
TN
Enumeration date
12/18/2006
Last updated
10/04/2018
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