Provider Demographics
NPI:1083683155
Name:COOKEVILLE REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:COOKEVILLE REGIONAL MEDICAL CENTER
Other - Org Name:COOKEVILLE REGIONAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-783-2481
Mailing Address - Street 1:1101 NEAL ST STE 103
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0917
Mailing Address - Country:US
Mailing Address - Phone:931-528-5578
Mailing Address - Fax:931-783-2566
Practice Address - Street 1:1101 NEAL ST STE 103
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0917
Practice Address - Country:US
Practice Address - Phone:931-783-2941
Practice Address - Fax:931-783-2566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOKEVILLE REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-14
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000197251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN447131Medicare Oscar/Certification