1528057791 NPI number — MAURY REGIONAL HOSPITAL

Table of content: (NPI 1528057791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528057791 NPI number — MAURY REGIONAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAURY REGIONAL 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:
MAURY REGIONAL HOME SERVICES
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:
1528057791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 S JAMES M CAMPBELL BLVD STE 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38401-5937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-490-4600
Provider Business Mailing Address Fax Number:
931-380-4103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 S JAMES M CAMPBELL BLVD STE 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38401-5937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-490-4600
Provider Business Practice Location Address Fax Number:
931-380-4103
Provider Enumeration Date:
10/19/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRINKLEY
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
931-540-4212

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  0000000180 , 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: 0447408 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39322 . This is a "BLUE CROSS BLUE SHIELD NO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".