MEDICARE: HOHENWALD MEDICAL CENTER

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	363AM0700X	Medical Physician Assistant	PA0000000781	TN
2	207Q00000X	Family Medicine Physician	MD0000021337	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4058796	OTHER	TN	BC/BS OF TENNESSEE
3	TN0101	OTHER	TN	AMERICHOICE

General Provider Information

NPI Number	:	1225092547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOHENWALD MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 5
Second Line	:
City	:	HOHENWALD
State	:	TN
Zip	:	38462-0005
Country	:	US
Telephone Number	:	931-796-7960
Fax Number	:	931-796-7790

Provider Business Practice Location Address
First Line	:	20 S PARK ST
Second Line	:
City	:	HOHENWALD
State	:	TN
Zip	:	38462-1413
Country	:	US
Telephone Number	:	931-796-7960
Fax Number	:	931-796-7790

Authorized Official
Title or Position	:	PARTNER
Name	:	MICHAEL PARKER
Credential	:
Telephone Number	:	931-796-7960

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	10/08/2007

Similar Medicare Providers

1568426567 — MICHAEL E PARKER PA-C
Practice Location Address:

20 S PARK ST
HOHENWALD, TN
38462-1413

Practice Phone: 931-796-7960
Practice Fax: 931-796-7790

1083005250 — HOHENWALD MEDICAL CENTER
Practice Location Address:

20 S PARK ST
HOHENWALD, TN
38462-1413

Practice Phone: 931-796-7960
Practice Fax: 931-796-7790

1043215882 — JOSEPH HENSLEY
Practice Location Address:

507 W MAIN ST
HOHENWALD, TN
38462-1319

Practice Phone: 931-796-5943
Practice Fax: 931-796-1269

1851372056 — RALPH ERNEST GROSSHEIM JR. DDS
Practice Location Address:

51 SMITH AVE
HOHENWALD, TN
38462-1124

Practice Phone: 931-796-2204
Practice Fax:

1538131073 — JAWAID KAMAL MD
Practice Location Address:

617 W MAIN ST
HOHENWALD, TN
38462-1355

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1346214566 — DR. LORI ANN GRILLO D.C.
Practice Location Address:

442 E MAIN ST
HOHENWALD, TN
38462-2605

Practice Phone: 931-796-2565
Practice Fax: 931-796-2566

Directions to “HOHENWALD MEDICAL CENTER ” Practice Location

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