Provider Demographics
NPI:1134110042
Name:COUNTY OF GRAINGER
Entity type:Organization
Organization Name:COUNTY OF GRAINGER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-828-3682
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-0863
Mailing Address - Country:US
Mailing Address - Phone:336-766-4448
Mailing Address - Fax:336-766-1279
Practice Address - Street 1:270 JUSTICE CENTER DRIVE,
Practice Address - Street 2:SUITE 101
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861
Practice Address - Country:US
Practice Address - Phone:865-828-3682
Practice Address - Fax:865-828-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2901341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000043400OtherBLUE CROSS BLUE SHIELD
TN000043400OtherTENNCARE & TENNCARE SELEC
TN000043400OtherBLUE CROSS 65
TN702004413OtherCARITEN & CARITEN SENIOR
TN3547821OtherTENNCARE BUREAU
TN3547821Medicaid
TN590002706OtherRAILROAD MEDICARE
MI7102000TN3786OtherBLUE CROSS BLUE SHIELD OF
TN000043400OtherBCBS MEMBERS
TN000043400OtherBCBS TENNCARE
TN100022008OtherPHP
FL912926000OtherFLORIDA MEDICAID
TN000043400OtherBLUECARE
TN000043400OtherBLUE NETWORK
TN702004413OtherCARITEN & CARITEN SENIOR
FL912926000OtherFLORIDA MEDICAID