=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699819003
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAKOMA REGIONAL HOSPITAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2007
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 TUSCULUM BLVD
-----------------------------------------------------
City | GREENEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37745-4279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-787-5000
-----------------------------------------------------
Fax | 423-787-5147
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 PRINCETON RD STE 1
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37601-2080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-787-5000
-----------------------------------------------------
Fax | 423-787-5147
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EVP/CFO
-----------------------------------------------------
Name | SHANE EDWIN HILTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-302-3467
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------