Provider Demographics
NPI:1033383617
Name:ST. MARY'S MEDICAL CENTER OF SCOTT COUNTY, INC.
Entity Type:Organization
Organization Name:ST. MARY'S MEDICAL CENTER OF SCOTT COUNTY, INC.
Other - Org Name:SCOTT COUNTY HOSPITAL CRNA'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-545-8000
Mailing Address - Street 1:18797 ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-2127
Mailing Address - Country:US
Mailing Address - Phone:423-569-5821
Mailing Address - Fax:423-569-5460
Practice Address - Street 1:18797 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-2127
Practice Address - Country:US
Practice Address - Phone:423-569-5821
Practice Address - Fax:423-569-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3370284Medicare PIN