Healthcare Provider Details

I. General information

NPI: 1790348100
Provider Name (Legal Business Name): HENRY COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
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
38242-4544
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-1220
  • Fax: 731-642-9588
Mailing address:
  • Phone: 731-644-8957
  • Fax: 731-642-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA CASTEEL
Title or Position: CEO
Credential:
Phone: 731-644-8478