Basic Information
| Provider Information | |||||||||
| NPI: | 1063055408 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAURY REGIONAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HOHENWALD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384621355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317964901 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5421 MAIN ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371744411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314862500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2019 | ||||||||
| LastUpdateDate: | 10/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | DAWSON | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 9314907019 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MAURY REGIONAL HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.