Healthcare Provider Details

I. General information

NPI: 1073765475
Provider Name (Legal Business Name): HENRY COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 TYSON AVE
PARIS TN
38242-4544
US

IV. Provider business mailing address

PO BOX 1030
PARIS TN
38242-1030
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-1220
  • Fax: 731-642-9588
Mailing address:
  • Phone: 731-642-1220
  • Fax: 731-642-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0000000057
License Number StateTN

VIII. Authorized Official

Name: MRS. LISA CASTEEL
Title or Position: CFO
Credential:
Phone: 731-644-8578