Organization
EAST TENNESSEE STATE UNIVERSITY
Active
Other names
Hancock County High School Based Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID D. COLLINS (CFO, VP FINANCE & ADMINISTRATION)
(423) 439-5884
Entity
Organization
Contact information
Practice address
2700 MAIN STREET, SNEEDVILLE, TN 37869-0723
(423) 733-2819
(423) 733-8509
Mailing address
PO BOX 70403, JOHNSON CITY, TN 37614-1703
(423) 439-4078
(423) 439-4060
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3709292
—
TN
Enumeration date
08/25/2006
Last updated
07/21/2022
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