Basic Information
Provider Information
NPI: 1770559726
EntityType: 2
ReplacementNPI:  
OrganizationName: CAMDEN GENERAL HOSPITAL, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: WEST TENNESSEE HEALTHCARE CAMDEN HOSPITAL
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 175 HOSPITAL DR
Address2:  
City: CAMDEN
State: TN
PostalCode: 383201617
CountryCode: US
TelephoneNumber: 7315840109
FaxNumber: 7315840124
Practice Location
Address1: 175 HOSPITAL DR
Address2:  
City: CAMDEN
State: TN
PostalCode: 383201617
CountryCode: US
TelephoneNumber: 7315840109
FaxNumber: 7315840124
Other Information
ProviderEnumerationDate: 02/28/2006
LastUpdateDate: 07/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ROSS
AuthorizedOfficialFirstName: JAMES
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: INTERIM PRESIDENT AND CEO
AuthorizedOfficialTelephone: 7315415000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
275N00000X00000000003TNY Hospital UnitsMedicare Defined Swing Bed Unit 

ID Information
IDTypeStateIssuerDescription
044Z31605TN MEDICAID
0000000000301TNDEPT OF HEALTH LICENSEOTHER


Home