Provider Demographics
NPI:1023038122
Name:MAURY REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:MAURY REGIONAL HOSPITAL
Other - Org Name:LEWIS AMBULATORY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRINKLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:931-540-4212
Mailing Address - Street 1:1224 TROTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4802
Mailing Address - Country:US
Mailing Address - Phone:931-381-1111
Mailing Address - Fax:931-540-4144
Practice Address - Street 1:617 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-1355
Practice Address - Country:US
Practice Address - Phone:931-796-6101
Practice Address - Fax:931-796-6203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAURY REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN440073Medicare Oscar/Certification
TN3283016Medicare PIN