Healthcare Provider Details

I. General information

NPI: 1134937345
Provider Name (Legal Business Name): PERRY COUNTY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 W MAIN ST
LINDEN TN
37096-7001
US

IV. Provider business mailing address

PO BOX 917
LINDEN TN
37096-0917
US

V. Phone/Fax

Practice location:
  • Phone: 931-589-2104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP TATUM
Title or Position: CEO
Credential:
Phone: 931-589-2104