1922003730 NPI number — RUSSELL COUNTY MEDICAL CENTER, INC

Table of content: (NPI 1922003730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922003730 NPI number — RUSSELL COUNTY MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSSELL COUNTY MEDICAL CENTER, INC
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:
1922003730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 198250
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:
30384-8250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-883-8000
Provider Business Mailing Address Fax Number:
276-889-4336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58 CARROLL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-883-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, COMMUNITY HEALTH SYSTEMS
Authorized Official Telephone Number:
888-373-9600

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  H1892 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 490002 . This is a "BLUE CARE TN MEDICAID IP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1868 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007676 . This is a "BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3101497 . This is a "BLUE CARE TN MEDICAID OP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: A2426600 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0170863000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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