Basic Information
| Provider Information | |||||||||
| NPI: | 1750323218 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HENDERSONVILLE HOSPITAL CORPORATION | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | PORTLAND MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 277463 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303847463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153251206 | ||||||||
| FaxNumber: | 6153251207 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 REDBUD DR | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371481673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153257301 | ||||||||
| FaxNumber: | 6153251207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MORRISON | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6153381100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0699930 | 01 | TN | CIGNA | OTHER | 5000036 | 01 | UNITED HEALTHCARE | OTHER | 0063022 | 01 | AETNA | OTHER | 1000118 | 01 | TN | TNCARE SELECT | OTHER | 1000118 | 01 | TN | BLUE CROSS | OTHER |