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NPI Code Detail

MEDICARE: LAUGHLIN MEMORIAL HOSPITAL, INC.

MEDICARE: LAUGHLIN MEMORIAL HOSPITAL, INC.
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
1282N00000XGeneral Acute Care Hospital0000000053TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21000367OTHERTNBLUE CROSS OF TENNESSEE

General Provider Information

NPI Number : 1881669778
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAUGHLIN MEMORIAL HOSPITAL, INC.
Provider Business Mailing Address
First Line : 311 PRINCETON RD STE 1
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-2026
Country : US
Telephone Number : 423-787-5000
Fax Number : 423-787-5009
Provider Business Practice Location Address
First Line : 1420 TUSCULUM BLVD
Second Line :
City : GREENEVILLE
State : TN
Zip : 37745-4279
Country : US
Telephone Number : 423-787-5000
Fax Number : 423-787-5009
Authorized Official
Title or Position : EVP/CFO
Name : MARY LYNN KRUTAK
Credential :
Telephone Number : 423-302-3423
Provider Enumeration Date : 02/22/2006
Last Update Date : 02/05/2018

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