Basic Information
| Provider Information | |||||||||
| NPI: | 1023296837 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOCTORS HOSPITAL OF MCMINN COUNTY, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WOODS REGIONAL DIALYSIS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 886 HIGHWAY 411 N | ||||||||
| Address2: | |||||||||
| City: | ETOWAH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373311912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232633600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 886 HIGHWAY 411 N | ||||||||
| Address2: | |||||||||
| City: | ETOWAH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373311912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232633600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2008 | ||||||||
| LastUpdateDate: | 10/02/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CLAPP | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4232633600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | 0442314 | 05 | TN | MEDICAID |