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General NPI Number Information
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NPI Number | 1306876669
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Entity Type | Organization
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Legal Business Name | CANNONB COUNTY HOSPITAL, LLC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 520 W MAIN ST
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City | SMITHVILLE
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State | TN
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Zip | 37166-1138
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Country | US
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Telephone | 615-215-5300
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Fax | 615-215-5600
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Provider Business Mailing Address
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Address Line | 520 W MAIN ST P.O. BOX 640
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City | SMITHVILLE
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State | TN
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Zip | 37166-1138
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Country | US
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Telephone | 615-215-5300
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Fax | 615-215-5600
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Authorized Official
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Title or Position | CONTROLLER
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Name | JESSE D BAKER
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Credential | CPA
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Telephone | 615-215-5354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 0000000138
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License Number State | TN
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