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	:	1952819351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELBYVILLE HOSPITAL COMPANY LLC

Provider Business Mailing Address
First Line	:	1970 N JACKSON ST
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-8240
Country	:	US
Telephone Number	:	931-455-3399
Fax Number	:	931-455-1806

Provider Business Practice Location Address
First Line	:	1970 N JACKSON ST
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-8240
Country	:	US
Telephone Number	:	931-455-3399
Fax Number	:	931-455-1806

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PAULA LALOR
Credential	:
Telephone Number	:	615-925-4565

Provider Enumeration Date	:	01/19/2018
Last Update Date	:	01/23/2018

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Directions to “SHELBYVILLE HOSPITAL COMPANY LLC ” Practice Location

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