Basic Information
| Provider Information | |||||||||
| NPI: | 1912997024 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MORRISTOWN HAMBLEN HEALTHCARE SYSTEM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1178 | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378161178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235864231 | ||||||||
| FaxNumber: | 4233182452 | ||||||||
| Practice Location | |||||||||
| Address1: | 908 WEST FOURTH NORTH STREET | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378143894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235864231 | ||||||||
| FaxNumber: | 4233182452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP/PATIENT ACCOUNT SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8653743090 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COVENANT HEALTH | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 282N00000X | 0000000073 | TN | Y | Hospitals | General Acute Care Hospital |
No ID Information.