Healthcare Provider Details

I. General information

NPI: 1134655731
Provider Name (Legal Business Name): WEST TENNESSEE REHABILITATION HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MOUNT PELIA ROAD
MARTIN TN
38237
US

IV. Provider business mailing address

9001 LIBERTY PARKWAY ATTN: ROBERT WISNER, SVP- REIMBURSEMENT
BIRMINGHAM AL
35242-7509
US

V. Phone/Fax

Practice location:
  • Phone: 731-261-1200
  • Fax: 731-587-6716
Mailing address:
  • Phone: 205-967-7116
  • Fax: 205-969-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT MCCALLUM
Title or Position: VICE PRESIDENT
Credential:
Phone: 205-970-5669