MEDICARE: HCA HEALTH SERVICES OF TENNESSEE, INC.

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	282NC0060X	Critical Access Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	184716000	OTHER	TN	TNCARE PREMIER/TBH -PSYCH

General Provider Information

NPI Number	:	1093981136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HCA HEALTH SERVICES OF TENNESSEE, INC.

Provider Business Mailing Address
First Line	:	313 N MAIN ST
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-1347
Country	:	US
Telephone Number	:	615-792-3030
Fax Number	:	615-792-2490

Provider Business Practice Location Address
First Line	:	313 N MAIN ST
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-1347
Country	:	US
Telephone Number	:	615-792-3030
Fax Number	:	615-792-2490

Authorized Official
Title or Position	:	CFO
Name	:	DAVID SUMMERS
Credential	:
Telephone Number	:	615-342-1005

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	06/22/2012

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