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General NPI Number Information
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NPI Number | 1164471413
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Entity Type | Organization
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Legal Business Name | DYERSBURG HOSPITAL COMPANY LLC
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 09/15/2017
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Provider Practice Location Address
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Address Line | 400 E TICKLE ST
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City | DYERSBURG
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State | TN
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Zip | 38024-3120
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Country | US
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Telephone | 731-285-2410
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100112
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City | ATLANTA
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State | GA
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Zip | 30384-0112
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Country | US
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Telephone | 660-826-5960
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Fax | 660-826-4852
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT DIRECTOR
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Name | DEBBIE T BREWER
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Credential | MBA
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Telephone | 615-465-7626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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