Basic Information
| Provider Information | |||||||||
| NPI: | 1376061275 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHELBYVILLE HOSPITAL COMPANY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TENNOVA FAMILY CARE- WARTRACE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 507 BLACKMAN BLVD W | ||||||||
| Address2: | |||||||||
| City: | WARTRACE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371832210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313890600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 507 BLACKMAN BLVD W | ||||||||
| Address2: | |||||||||
| City: | WARTRACE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371832210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313890600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LALOR | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR/DELEGATED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6159254565 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SHELBYVILLE HOSPITAL COMPANY LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 000000002 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.