1275531956 NPI number — COOKEVILLE REGIONAL MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275531956 NPI number — COOKEVILLE REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOKEVILLE REGIONAL MEDICAL CENTER
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:
1275531956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL CENTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOKEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38501-1760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-783-2602
Provider Business Mailing Address Fax Number:
931-783-5666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38501-1760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-783-2602
Provider Business Practice Location Address Fax Number:
931-783-5666
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KEY
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
931-783-2481

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0000000095 , 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: 0064651 . This is a "AETNA PROVIDER ID #" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 369883 . This is a "AMERICHOICE PIN # FOR PROFESSIONAL BILING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3870577 . This is a "AMERIGROUP PIN # FOR PROFESSIONAL BILLING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4109479 . This is a "BCBST&TNCARE PIN PROF FEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 27478 . This is a "AMERIGROUP PIN # FOR PROFESSIONAL BILLING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3088600 . This is a "BCBST&TNCARE PIN PROF FEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4088879 . This is a "BCBST&TNCARE PIN PROF FEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3071971 . This is a "AMERIGROUP PIN # FOR PROFESSIONAL BILLING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3091395 . This is a "AMERIGROUP PIN # FOR PROFESSIONAL BILLING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 369882 . This is a "AMERICHOICE PIN # FOR PROFESSIONAL BILLING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4123672 . This is a "BCBST&TNCARE PIN PROF FEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4139913 . This is a "BCBST&TNCARE PIN PROF FEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0104 . This is a "AMERICHOICE PIN # FOR PROFESSIONAL BILLING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1000116 . This is a "TENNCARE PROVIDER ID #" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3064481 . This is a "AMERIGROUP PIN # FOR PROFESSIONAL BILLING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3088599 . This is a "BCBST&TNCARE PIN PROF FEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3806863 . This is a "AMERIGROUP PIN # FOR PROFESSIONAL BILLING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4042505 . This is a "BCBST&TNCARE PIN PROF FEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3079003 . This is a "BCBST&TNCARE PIN PROF FEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3163698 . This is a "BCBST&TNCARE PIN PROF FEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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