MEDICARE: JEFFERSON CITY OPERATIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1093176950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON CITY OPERATIONS, LLC

Provider Business Mailing Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	423-473-5751
Fax Number	:	423-339-8344

Provider Business Practice Location Address
First Line	:	336 W OLD ANDREW JOHNSON HWY
Second Line	:
City	:	JEFFERSON CITY
State	:	TN
Zip	:	37760-5212
Country	:	US
Telephone Number	:	865-475-6097
Fax Number	:	865-475-5236

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	CINDY CROSS
Credential	:
Telephone Number	:	423-473-5867

Provider Enumeration Date	:	03/18/2016
Last Update Date	:	03/21/2016

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