Basic Information
| Provider Information | |||||||||
| NPI: | 1790372027 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT THOMAS HICKMAN HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 E SWAN ST | ||||||||
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| City: | CENTERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370331417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317296784 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1518 HIGHWAY 100 | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370332014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317293091 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2020 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6152846845 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAINT THOMAS HICKMAN HOSPITAL | ||||||||
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| NPICertificationDate: | 12/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.