1972585347 NPI number — JEFFERSON COUNTY HMA LLC

Table of content: (NPI 1972585347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972585347 NPI number — JEFFERSON COUNTY HMA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON COUNTY HMA 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:
TENNOVA HEALTHCARE-JEFFERSON MEMORIAL 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:
1972585347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37760-5281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-471-2500
Provider Business Mailing Address Fax Number:
865-471-2450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37760-5281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-471-2500
Provider Business Practice Location Address Fax Number:
865-471-2450
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LALOR
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR/DELEGATED OFFICIAL
Authorized Official Telephone Number:
629-215-3953

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0000000038 , 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: 0440056 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118902900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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