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607 Baxter St Johnson City TN 37601-4003 | |
| (423) 232-2670 | |
| (423) 928-0381 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 607 Baxter St, Johnson City, Tennessee |
| Authorized Official Name and Position | Teresa M Kidd (PRESIDENT AND CEO) |
| Authorized Official Contact | 4234673600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 9054 Gray TN 37615-9054 Ph: (423) 467-3600 | 607 Baxter St Johnson City TN 37601-4003 Ph: (423) 232-2670 |
| NPI Number | 1134282551 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 10/04/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134282551 | NPI | - | NPPES |
| SAME AS MEDICARE #S | Medicaid | TN | |
| 49-4914-5 | Medicaid | VA |
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