Organization
EAST TENNESSEE STATE UNIVERSITY
Active
Other names
JCDC/JCHA Partners for Health
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BETTY J KING (ACTING CHIEF FINANCIAL OFFICER)
(423) 439-4414
Entity
Organization
Contact information
Practice address
1134-1136 E. MAIN STREET, JOHNSON CITY, TN 37601
(423) 722-0808
(423) 929-2930
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
—
1522314
—
TN
Enumeration date
11/12/2010
Last updated
07/21/2022
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