1790756203 NPI number — CLEVELAND TENNESSEE HOSPITAL COMPANY LLC

Table of content: (NPI 1790756203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790756203 NPI number — CLEVELAND TENNESSEE HOSPITAL COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND 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:
TENNOVA HEALTHCARE-CLEVELAND
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:
1790756203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 198029
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-8029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-559-6000
Provider Business Mailing Address Fax Number:
423-559-6653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2305 CHAMBLISS AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37311-3847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-559-6000
Provider Business Practice Location Address Fax Number:
423-559-6653
Provider Enumeration Date:
02/01/2006

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:  0000000006 , 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: 0440185 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5000072 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0140006296 . This is a "HEALTHSOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000017 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01CCHTN . This is a "COMP HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 030433100 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00136133A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A3731201 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003130200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com