Healthcare Provider Details

I. General information

NPI: 1124536990
Provider Name (Legal Business Name): SCOTT COUNTY COMMUNITY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18797 ALBERTA ST
ONEIDA TN
37841-2127
US

IV. Provider business mailing address

18797 ALBERTA ST
ONEIDA TN
37841-2127
US

V. Phone/Fax

Practice location:
  • Phone: 423-569-8521
  • Fax: 423-286-5306
Mailing address:
  • Phone: 423-569-8521
  • Fax: 423-286-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN WILBER
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 423-286-5307