Organization
EAST TENNESSEE STATE UNIVERSITY
Active
Other names
Hancock County Elementary School Based Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY J. KING (ACTING CHIEF FINANCIAL OFFICER)
(423) 439-4414
Entity
Organization
Contact information
Practice address
391 COURT SQ, SNEEDVILLE, TN 37869-0723
(423) 733-2819
(423) 733-8509
Mailing address
PO BOX 70403, 365 STOUT DRIVE, JOHNSON CITY, TN 37614-1703
(423) 439-4515
(423) 439-5780
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
09/08/2006
Last updated
07/21/2022
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