Basic Information
Provider Information | |||||||||
NPI: | 1306868682 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CAMDEN GENERAL HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CAMDEN ER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1804 HIGHWAY 45 BYP | ||||||||
Address2: | SUITE 604 | ||||||||
City: | JACKSON | ||||||||
State: | TN | ||||||||
PostalCode: | 383054436 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7316608759 | ||||||||
FaxNumber: | 7316608739 | ||||||||
Practice Location | |||||||||
Address1: | 175 HOSPITAL DR | ||||||||
Address2: |   | ||||||||
City: | CAMDEN | ||||||||
State: | TN | ||||||||
PostalCode: | 383201617 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7315846135 | ||||||||
FaxNumber: | 7315840124 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/24/2006 | ||||||||
LastUpdateDate: | 05/16/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | UTLEY | ||||||||
AuthorizedOfficialFirstName: | KAREN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 7314256733 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | CAMDEN GENERAL HOSPITAL | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X |   |   | N |   | Hospitals | General Acute Care Hospital | Critical Access | 282NC2000X |   |   | N |   | Hospitals | General Acute Care Hospital | Children | 282NR1301X |   |   | N |   | Hospitals | General Acute Care Hospital | Rural | 282NW0100X |   |   | N |   | Hospitals | General Acute Care Hospital | Women | 282N00000X |   |   | Y |   | Hospitals | General Acute Care Hospital |   |
No ID Information.