Healthcare Provider Details

I. General information

NPI: 1992397152
Provider Name (Legal Business Name): SAINT THOMAS RIVER PARK HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 VO TECH DR STE 4
MCMINNVILLE TN
37110-1329
US

IV. Provider business mailing address

300 20TH AVE N STE 403
NASHVILLE TN
37203-5180
US

V. Phone/Fax

Practice location:
  • Phone: 931-474-1224
  • Fax:
Mailing address:
  • Phone: 615-289-3257
  • Fax:

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: CANDACE GARRETT
Title or Position: MANAGER OF BUSINESS OPERATIONS
Credential:
Phone: 615-290-7184