MEDICARE: MCNAIRY HOSPITAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	0000000081	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4048516	OTHER	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154392710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCNAIRY HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 501060
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63150-1060
Country	:	US
Telephone Number	:	731-645-3221
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 E POPLAR AVE
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-1828
Country	:	US
Telephone Number	:	731-645-3221
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	TARA P RICHARDSON
Credential	:
Telephone Number	:	615-221-3672

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	04/27/2016

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Directions to “MCNAIRY HOSPITAL CORPORATION ” Practice Location

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