Healthcare Provider Details

I. General information

NPI: 1184682874
Provider Name (Legal Business Name): S P ACQUISITION CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HIGHWAY 28
JASPER TN
37347-3638
US

IV. Provider business mailing address

1000 HIGHWAY 28
JASPER TN
37347-3638
US

V. Phone/Fax

Practice location:
  • Phone: 423-837-9500
  • Fax: 423-837-3333
Mailing address:
  • Phone: 423-837-9500
  • Fax: 423-837-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0000002180
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0000000077
License Number StateTN

VIII. Authorized Official

Name: MR. DANIEL S. SLIPKOVICH
Title or Position: CEO
Credential:
Phone: 615-764-3000