Healthcare Provider Details

I. General information

NPI: 1861538308
Provider Name (Legal Business Name): UNICOI COUNTY MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GREENWAY CIR
ERWIN TN
37650-2177
US

IV. Provider business mailing address

100 GREENWAY CIR
ERWIN TN
37650-2177
US

V. Phone/Fax

Practice location:
  • Phone: 423-743-1229
  • Fax: 423-743-2816
Mailing address:
  • Phone: 423-743-1229
  • Fax: 423-743-2816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number1374
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BILLY MOORE
Title or Position: DIR PHCY SVCS
Credential: DPH
Phone: 423-743-1272