Healthcare Provider Details

I. General information

NPI: 1114972007
Provider Name (Legal Business Name): CANNON COUNTY HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 DOOLITTLE RD
WOODBURY TN
37190-1139
US

IV. Provider business mailing address

324 DOOLITTLE RD
WOODBURY TN
37190-1139
US

V. Phone/Fax

Practice location:
  • Phone: 615-563-3153
  • Fax: 615-563-1201
Mailing address:
  • Phone: 615-563-3153
  • Fax: 615-563-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0000000009
License Number StateTN

VIII. Authorized Official

Name: MR. ROBERT M LUTHER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 615-563-4001