Basic Information
| Provider Information | |||||||||
| NPI: | 1801844873 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RIVER PARK HOSPITAL LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | RIVER PARK HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1559 SPARTA ST | ||||||||
| Address2: | |||||||||
| City: | MC MINNVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371101316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318154000 | ||||||||
| FaxNumber: | 9318154710 | ||||||||
| Practice Location | |||||||||
| Address1: | 1559 SPARTA ST | ||||||||
| Address2: | |||||||||
| City: | MC MINNVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371101316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318154000 | ||||||||
| FaxNumber: | 9318154710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 02/19/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COFFEY | ||||||||
| AuthorizedOfficialFirstName: | S | ||||||||
| AuthorizedOfficialMiddleName: | RAY | ||||||||
| AuthorizedOfficialTitleorPosition: | VP, REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 6157643009 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 0000002909 | TN | Y | Hospital Units | Medicare Defined Swing Bed Unit |
No ID Information.