Healthcare Provider Details

I. General information

NPI: 1831171693
Provider Name (Legal Business Name): CAMPBELL COUNTY HMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 E CENTRAL AVE
LAFOLLETTE TN
37766-2055
US

IV. Provider business mailing address

923 E CENTRAL AVE
LAFOLLETTE TN
37766-2055
US

V. Phone/Fax

Practice location:
  • Phone: 423-907-1200
  • Fax: 423-907-1189
Mailing address:
  • Phone: 423-907-1200
  • Fax: 423-907-1163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number0000000008
License Number StateTN

VIII. Authorized Official

Name: PAULA M LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 629-215-3953