Basic Information
| Provider Information | |||||||||
| NPI: | 1265051577 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAURY REGIONAL HOSPITAL MARSHALL MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MRMG MT. PLEASANT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 854 W JAMES M CAMPBELL BLVD STE 303 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384014672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313795821 | ||||||||
| FaxNumber: | 9313795867 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 S CROSS BRIDGES RD | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384741714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313795821 | ||||||||
| FaxNumber: | 9313795867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2020 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BRINKELY | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9315404212 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.