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General NPI Number Information
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NPI Number | 1689665754
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Entity Type | Organization
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Legal Business Name | BOLIVAR GENERAL HOSPITAL, INC.
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 650 NUCKOLLS RD
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City | BOLIVAR
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State | TN
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Zip | 38008-1532
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Country | US
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Telephone | 731-658-3100
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Fax | 731-659-0259
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Provider Business Mailing Address
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Address Line | 650 NUCKOLLS RD
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City | BOLIVAR
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State | TN
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Zip | 38008-1532
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Country | US
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Telephone | 731-658-3100
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Fax | 731-659-0259
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MS. TINA PRESCOTT
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Credential |
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Telephone | 731-541-5000
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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 | 0000000062
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License Number State | TN
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