Healthcare Provider Details

I. General information

NPI: 1659567527
Provider Name (Legal Business Name): PERRY COUNTY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7723 CLEARVIEW CHURCH LN
LYLES TN
37098-1609
US

IV. Provider business mailing address

PO BOX 129
LYLES TN
37098-0129
US

V. Phone/Fax

Practice location:
  • Phone: 931-670-5520
  • Fax: 931-670-5312
Mailing address:
  • Phone: 931-670-5520
  • Fax: 931-670-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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