1073687448 NPI number — CUMBERLAND RIVER HOSPITAL INC

Table of content: (NPI 1073687448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073687448 NPI number — CUMBERLAND RIVER HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMBERLAND RIVER HOSPITAL INC
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:
CUMBERLAND RIVER HOSPITAL
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:
1073687448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 OLD JEFFERSON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CELINA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38551-4040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-243-3581
Provider Business Mailing Address Fax Number:
931-243-5219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 OLD JEFFERSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CELINA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38551-4040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-243-3581
Provider Business Practice Location Address Fax Number:
931-243-5219
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STRONG
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
CAO
Authorized Official Telephone Number:
931-243-3581

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  15 , 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: 044S141 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100034800 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0713454 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: A3855100 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: K65939910 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000134 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5534 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0440141 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000134 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4139416 . This is a "NEW BC PROV #" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4139416 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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