Healthcare Provider Details

I. General information

NPI: 1992718688
Provider Name (Legal Business Name): SAINT THOMAS HICKMAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/27/2022
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E SWAN STREET
CENTERVILLE TN
37033
US

IV. Provider business mailing address

300 20TH AVE N STE 403
NASHVILLE TN
37203-5180
US

V. Phone/Fax

Practice location:
  • Phone: 931-729-3091
  • Fax: 931-729-0809
Mailing address:
  • Phone: 615-289-3257
  • Fax: 615-673-4541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA R DAVIS
Title or Position: CFO
Credential:
Phone: 615-284-6845