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Organization

STATE OF TENNESSEE

Active
Other names
Children's Special Services
Organization subpart
No

Provider details

NPI number
Authorized official
BARBARA J WHITWELL (OFFICE SUPERVISOR)
(931) 490-8334
Entity
Organization

Contact information

Practice address
1216 TROTWOOD AVE, COLUMBIA, TN 38401-6406
(931) 380-2532
(931) 380-3364
Mailing address
1216 TROTWOOD AVE, COLUMBIA, TN 38401-6406
(931) 380-2532
(931) 380-3364

Taxonomy

Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0148352
BC/BS & TENNCARE SELECT
TN
01
3031979
BC/BS & TENNCARE SELECT
TN
05
4448058
TN
Enumeration date
08/23/2006
Last updated
09/25/2012
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