1467408781 NPI number — SOUTHERN TENNESSEE MEDICAL CENTER LLC

Table of content: (NPI 1467408781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467408781 NPI number — SOUTHERN TENNESSEE MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN TENNESSEE MEDICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHERN TENNESSEE REGIONAL HEALTH SYSTEM WINCHESTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467408781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 SEVEN SPRINGS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-4536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-920-7000
Provider Business Mailing Address Fax Number:
615-920-8913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37398-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-967-8200
Provider Business Practice Location Address Fax Number:
931-962-8836
Provider Enumeration Date:
05/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAWRENCE
Authorized Official First Name:
CHARLOTTE
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
615-920-7000

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0000000139 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 031051900 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000048 . This is a "BLUE SELECT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 010069 . This is a "BLUE CROSS OF ALABLAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1000048 . This is a "TNCARE BLUE CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0440058 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000048 . This is a "BLUE CROSS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: A3739800 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100029904 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023574300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".