MEDICARE: SHELBYVILLE HOSPITAL COMPANY 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	261QR1300X	Rural Health Clinic/Center	0000000002	TN

General Provider Information

NPI Number	:	1548788458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELBYVILLE HOSPITAL COMPANY LLC

Provider Business Mailing Address
First Line	:	1612 N MAIN ST STE A
Second Line	:
City	:	SHELBYVILLE
State	:	TN
Zip	:	37160-2392
Country	:	US
Telephone Number	:	931-680-8910
Fax Number	:	931-685-4158

Provider Business Practice Location Address
First Line	:	1612 N MAIN ST STE A
Second Line	:
City	:	SHELBYVILLE
State	:	TN
Zip	:	37160-2392
Country	:	US
Telephone Number	:	931-680-8910
Fax Number	:	931-685-4158

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CHERI SUZETTE KANE
Credential	:
Telephone Number	:	615-465-7463

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	07/21/2022

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