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Provider Information for 1861538308


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UNICOI COUNTY MEMORIAL HOSPITAL INC

Other Names:  
Doing Business As: 
UNICOI COUNTY MEMORIAL HOSPITAL

Organization Subpart: NO

NPI: 1861538308
Last Updated: 2011-12-20
Certification Date:

Details

NameValue
NPI1861538308
Enumeration Date2007-01-30
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: BILLY MOORE DPH
Title: DIR PHCY SVCS
Phone: 4237431272
Mailing Address 100 GREENWAY CIR
ERWIN, TN 37650-2177
United States

Phone: 423-743-1229 | Fax:423-743-2816
 
Primary Practice Address 100 GREENWAY CIR
ERWIN, TN 37650-2177
United States

Phone: 423-743-1229 | Fax:423-743-2816
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)4414087NCPDP Provider Identification Number
MEDICAIDTN7440197
MEDICAIDTN0445077
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 3336I0012X - Pharmacy - Institutional Pharmacy
Yes 3336H0001X - Pharmacy - Home Infusion Therapy PharmacyTN1374