Healthcare Provider Details

I. General information

NPI: 1245275254
Provider Name (Legal Business Name): SAINT THOMAS HICKMAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E SWAN ST
CENTERVILLE TN
37033-1417
US

IV. Provider business mailing address

135 E SWAN ST
CENTERVILLE TN
37033-1417
US

V. Phone/Fax

Practice location:
  • Phone: 931-729-4271
  • Fax: 931-729-0174
Mailing address:
  • Phone: 931-729-4271
  • Fax: 931-729-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0000000056
License Number StateTN

VIII. Authorized Official

Name: MR. KEVIN CAMPBELL
Title or Position: ADMINISTRATION
Credential:
Phone: 931-729-6790