=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558729228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | T J HEALTH COLUMBIA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2016
-----------------------------------------------------
Last Update Date | 02/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 WESTLAKE DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42728-1123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-384-7516
-----------------------------------------------------
Fax | 270-384-0583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301 N RACE ST
-----------------------------------------------------
City | GLASGOW
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42141-3454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-651-4444
-----------------------------------------------------
Fax | 270-651-4892
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | NEIL THORNBURY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 270-651-4159
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------