Healthcare Provider Details

I. General information

NPI: 1114564432
Provider Name (Legal Business Name): COCKE COUNTY HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 4TH ST STE 305
NEWPORT TN
37821-3735
US

IV. Provider business mailing address

435 2ND ST
NEWPORT TN
37821-3703
US

V. Phone/Fax

Practice location:
  • Phone: 423-613-6381
  • Fax: 423-613-6382
Mailing address:
  • Phone: 423-625-2200
  • 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: PAULA LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 629-215-3953