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NPI Code Detail

MEDICARE: LP MOUNTAIN CITY LLC

MEDICARE: LP MOUNTAIN CITY LLC
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
1314000000XSkilled Nursing Facility140TN
2313M00000XNursing Facility/Intermediate Care Facility140TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235320524
Entity Type Code : Organization
Provider Name (Legal Business Name) : LP MOUNTAIN CITY LLC
Provider Business Mailing Address
First Line : 12201 BLUEGRASS PARKWAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2361
Country : US
Telephone Number : 502-568-7800
Fax Number : 502-568-7150
Provider Business Practice Location Address
First Line : 919 MEDICAL PARK DR
Second Line :
City : MOUNTAIN CITY
State : TN
Zip : 37683-1042
Country : US
Telephone Number : 423-727-7800
Fax Number : 423-727-5508
Authorized Official
Title or Position : CFO
Name : MR. JOHN HARRISON
Credential :
Telephone Number : 502-568-7800
Provider Enumeration Date : 08/05/2007
Last Update Date : 04/04/2023

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Directions to “LP MOUNTAIN CITY LLC ” Practice Location

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