1316918121 NPI number — BROWNSVILLE HOSPITAL CORPORATION

Table of content: (NPI 1316918121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316918121 NPI number — BROWNSVILLE HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWNSVILLE HOSPITAL CORPORATION
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:
HAYWOOD PARK COMMUNITY 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:
1316918121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2545 N WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38012-1610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2545 N WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38012-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-772-4110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLTSFORD
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTH OFFICIAL / DIR BUS OFFICE SUP
Authorized Official Telephone Number:
615-465-7466

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  0000000059 , 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: 440174 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3108 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4050786 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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