Healthcare Provider Details

I. General information

NPI: 1033383617
Provider Name (Legal Business Name): ST. MARY'S MEDICAL CENTER OF SCOTT COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 05/19/2008
Certification Date:
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: 423-569-5821
  • Fax: 423-569-5460
Mailing address:
  • Phone: 423-569-5821
  • Fax: 423-569-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DEBRA K LONDON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 865-545-8000