Healthcare Provider Details

I. General information

NPI: 1225049570
Provider Name (Legal Business Name): HICKMAN COMMUNITY HEALTH CARESERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5047 HIGHWAY 100
LYLES TN
37098-1878
US

IV. Provider business mailing address

5047 HIGHWAY 100
LYLES TN
37098-1878
US

V. Phone/Fax

Practice location:
  • Phone: 931-670-6525
  • Fax: 931-670-6527
Mailing address:
  • Phone: 931-670-6525
  • Fax: 931-670-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA L MATHIS
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 931-729-6779