Healthcare Provider Details

I. General information

NPI: 1366529323
Provider Name (Legal Business Name): METHODIST HEALTHCARE - FAYETTE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 LAKEVIEW RD
SOMERVILLE TN
38068-9737
US

IV. Provider business mailing address

1211 UNION AVE SUITE 600
MEMPHIS TN
38104-6638
US

V. Phone/Fax

Practice location:
  • Phone: 901-465-3594
  • Fax:
Mailing address:
  • Phone: 901-516-0725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number0000000047
License Number StateTN

VIII. Authorized Official

Name: MR. CHRIS MCLEAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 901-516-0696