Healthcare Provider Details

I. General information

NPI: 1750363115
Provider Name (Legal Business Name): COPPER BASIN COMMUNITY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 MEDICAL CENTER DRIVE
COPPERHILL TN
37317
US

IV. Provider business mailing address

PO BOX 990
COPPERHILL TN
37317-0990
US

V. Phone/Fax

Practice location:
  • Phone: 423-496-5511
  • Fax: 423-496-9311
Mailing address:
  • Phone: 423-496-5511
  • Fax: 423-496-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0000000094
License Number StateTN

VIII. Authorized Official

Name: DANIEL C JOHNSON
Title or Position: CEO
Credential:
Phone: 423-496-5511