1407827157 NPI number — MCKENZIE TENNESSEE HOSPITAL COMPANY LLC

Table of content: (NPI 1407827157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407827157 NPI number — MCKENZIE TENNESSEE HOSPITAL COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCKENZIE TENNESSEE HOSPITAL COMPANY 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:
Provider Other Organization Name Type Code:
6
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:
1407827157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 501092
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63150-1092
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:
161 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC KENZIE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38201-1636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-352-5344
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUSSEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VP, GROUP OPERATIONS
Authorized Official Telephone Number:
888-373-9600

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0000000011 , 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: 25796 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 440008 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4050785 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 136768 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26664 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0440182 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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