Basic Information
| Provider Information | |||||||||
| NPI: | 1538114434 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HENDERSONVILLE HOSPITAL CORPORATION | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | TRISTAR HENDERSONVILLE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 355 NEW SHACKLE ISLAND RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370752300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153381000 | ||||||||
| FaxNumber: | 6152644281 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 NEW SHACKLE ISLAND RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370752300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153381000 | ||||||||
| FaxNumber: | 6152644281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MORRISON | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6153381100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1000121 | 01 | BLUE CROSS | OTHER | 0552273 | 05 | IA | MEDICAID | 0832344 | 05 | OH | MEDICAID | 908322700 | 05 | FL | MEDICAID | 000787806X | 05 | GA | MEDICAID | 01621499 | 05 | KY | MEDICAID | 0440194 | 05 | TN | MEDICAID | 200462150A | 05 | IN | MEDICAID | 3026333 | 05 | WA | MEDICAID | 511100 | 05 | KS | MEDICAID | 016114506 | 05 | MO | MEDICAID | 023982800 | 05 | MN | MEDICAID | 072858601 | 05 | TX | MEDICAID | 145257105 | 05 | AR | MEDICAID | 1702528 | 05 | LA | MEDICAID | 200068190A | 05 | OK | MEDICAID | 40-4674462 | 05 | MI | MEDICAID | 4400194 | 05 | NC | MEDICAID | HEN0194N | 05 | AL | MEDICAID | 0401001 | 01 | HEALTHSPRING | OTHER | 269671 | 05 | OR | MEDICAID | 5000040 | 01 | UNITED HEALTHCARE | OTHER | 835928 | 05 | AZ | MEDICAID | 10025086300 | 05 | NE | MEDICAID |