Healthcare Provider Details

I. General information

NPI: 1134250335
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTER OF MONTEAGLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 WEST MAIN STREET
MONTEAGLE TN
37356
US

IV. Provider business mailing address

PO BOX 1148 926 WEST MAIN STREET
MONTEAGLE TN
37356-1148
US

V. Phone/Fax

Practice location:
  • Phone: 931-924-6006
  • Fax: 931-924-6007
Mailing address:
  • Phone: 931-924-6006
  • Fax: 931-924-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN5310
License Number StateTN

VIII. Authorized Official

Name: KRISTA A GARNER
Title or Position: OWNER PROVIDER
Credential: FNPC
Phone: 931-924-6006