Healthcare Provider Details

I. General information

NPI: 1801050844
Provider Name (Legal Business Name): SHELBYVILLE HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MAGNOLIA DR
LYNCHBURG TN
37352-8373
US

IV. Provider business mailing address

12 MAGNOLIA DR
LYNCHBURG TN
37352-8373
US

V. Phone/Fax

Practice location:
  • Phone: 931-759-5044
  • Fax:
Mailing address:
  • Phone: 931-759-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateTN

VIII. Authorized Official

Name: MR. ALAN LOVELACE
Title or Position: CFO
Credential:
Phone: 931-685-8254