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General NPI Number Information
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NPI Number | 1861857567
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Entity Type | Organization
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Legal Business Name | TAKOMA REGIONAL HOSPITAL, INC.
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 5000 MONARCH PT
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City | GREENEVILLE
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State | TN
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Zip | 37745-4275
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Country | US
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Telephone | 423-798-6630
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Fax |
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Provider Business Mailing Address
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Address Line | 105 W STONE DR STE 6A
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City | KINGSPORT
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State | TN
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Zip | 37660-3256
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Country | US
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Telephone | 423-408-7220
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Fax | 423-408-7405
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Authorized Official
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Title or Position | VP REIMBURSEMENT
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Name | GREGORY LEE WILGOCKI
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Credential |
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Telephone | 423-431-5794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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