Healthcare Provider Details

I. General information

NPI: 1093760712
Provider Name (Legal Business Name): HMA FENTRESS COUNTY GENERAL HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 CENTRAL AVE W
JAMESTOWN TN
38556-3031
US

IV. Provider business mailing address

436 CENTRAL AVE W
JAMESTOWN TN
38556-3031
US

V. Phone/Fax

Practice location:
  • Phone: 931-879-8171
  • Fax:
Mailing address:
  • Phone: 931-879-8171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0000000048
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: PAULA M LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 615-925-4565