Organization
EAST TENNESSEE STATE UNIVERSITY
Active
Other names
Johnson City Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY J KING (SENIOR ASSOCIATE VICE PRESIDENT F&A)
(423) 439-4414
Entity
Organization
Contact information
Practice address
2151 CENTURY LANE, JOHNSON CITY, TN 37604
(423) 926-2500
(423) 926-5999
Mailing address
365 STOUT DRIVE, BOX 70403, 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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0441901
—
TN
Enumeration date
08/25/2006
Last updated
07/21/2022
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