Provider Demographics
NPI:1003144494
Name:UNICOI COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:UNICOI COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-743-3141
Mailing Address - Street 1:100 GREENWAY CIR
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-2177
Mailing Address - Country:US
Mailing Address - Phone:423-743-3141
Mailing Address - Fax:423-743-2887
Practice Address - Street 1:100 GREENWAY CIR
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-2177
Practice Address - Country:US
Practice Address - Phone:423-743-3141
Practice Address - Fax:423-743-2887
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNICOI COUNTY MEMORIAL HOSPITAL,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3610099OtherMEDICARE PTAN