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General NPI Number Information
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NPI Number | 1427079052
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Entity Type | Organization
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Legal Business Name | DYERSBURG HOSPITAL CORPORATION
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 09/12/2008
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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 | 731-288-3606
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Fax | 731-288-3626
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Provider Business Mailing Address
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Address Line | 7100 COMMERCE WAY SUITE 180
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City | BRENTWOOD
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State | TN
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Zip | 37027-2829
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Country | US
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Telephone | 615-465-7000
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PROVIDER ENROLLMENT
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Name | DEBBIE BREWER
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Credential |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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