MEDICARE: TAKOMA REGIONAL HOSPITAL 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	314000000X	Skilled Nursing Facility	620701119	TN
2	313M00000X	Nursing Facility/Intermediate Care Facility	620701119	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0125021	OTHER	TN	BLUE CROSS - BLUE SHIELD
2	0740620001	OTHER	TN	PALMETTO GOVERNMENT ADMIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679570998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAKOMA REGIONAL HOSPITAL INC

Provider Business Mailing Address
First Line	:	311 PRINCETON RD STE 1
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2026
Country	:	US
Telephone Number	:	423-638-9226
Fax Number	:	423-638-1561

Provider Business Practice Location Address
First Line	:	801 E MCKEE ST
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37743-6010
Country	:	US
Telephone Number	:	423-638-9226
Fax Number	:	423-638-1561

Authorized Official
Title or Position	:	EVP/CFO
Name	:	SHANE EDWIN HILTON
Credential	:
Telephone Number	:	423-302-3467

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	04/17/2024

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Directions to “TAKOMA REGIONAL HOSPITAL INC ” Practice Location

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