Provider Demographics
NPI:1053648741
Name:HMA FENTRESS COUNTY GENERAL HOSPITAL LLC
Entity Type:Organization
Organization Name:HMA FENTRESS COUNTY GENERAL HOSPITAL LLC
Other - Org Name:TENNOVA HEALTHCARE-JAMESTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-1500
Mailing Address - Country:US
Mailing Address - Phone:931-879-8171
Mailing Address - Fax:931-879-4896
Practice Address - Street 1:436 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3031
Practice Address - Country:US
Practice Address - Phone:931-879-8171
Practice Address - Fax:931-879-4896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HMA FENTRESS COUNTY GENERAL HOSPITAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-17
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN044S083Medicaid
TN044S083Medicaid