Provider Demographics
NPI:1306818265
Name:STATE OF TENNESSEE STATE F & A PAYROLL
Entity type:Organization
Organization Name:STATE OF TENNESSEE STATE F & A PAYROLL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-785-3321
Mailing Address - Street 1:100 MOCCASIN BEND RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-4415
Mailing Address - Country:US
Mailing Address - Phone:423-265-2271
Mailing Address - Fax:423-875-3454
Practice Address - Street 1:100 MOCCASIN BEND RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-4415
Practice Address - Country:US
Practice Address - Phone:423-265-2271
Practice Address - Fax:423-875-3454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF TENNESSEE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-06
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3282227Medicaid
TN3282227Medicaid
TN3282227Medicare ID - Type UnspecifiedMEDICARE B