1104099712 NPI number — DECATUR COUNTY GENERAL HOSPITAL

Table of content: (NPI 1104099712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104099712 NPI number — DECATUR COUNTY GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DECATUR COUNTY GENERAL HOSPITAL
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:
Provider Other Organization Name Type Code:
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:
1104099712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38351-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-944-6420
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
969 TENNESSEE AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARSONS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38363-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-847-3031
Provider Business Practice Location Address Fax Number:
731-847-1122
Provider Enumeration Date:
04/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENSON
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
RCD
Authorized Official Telephone Number:
336-944-6420

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  0000000028 , 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)