MEDICARE: SHELBYVILLE HOSPITAL CORPORATION

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	363A00000X	Physician Assistant		TN
2	261QR1300X	Rural Health Clinic/Center		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

General Provider Information

NPI Number	:	1801050844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELBYVILLE HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	12 MAGNOLIA DR
Second Line	:
City	:	LYNCHBURG
State	:	TN
Zip	:	37352-8373
Country	:	US
Telephone Number	:	931-759-5044
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 MAGNOLIA DR
Second Line	:
City	:	LYNCHBURG
State	:	TN
Zip	:	37352-8373
Country	:	US
Telephone Number	:	931-759-5044
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. ALAN LOVELACE
Credential	:
Telephone Number	:	931-685-8254

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	01/12/2009

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Directions to “SHELBYVILLE HOSPITAL CORPORATION ” Practice Location

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