Provider Demographics
NPI:1093300717
Name:CAMPBELL COUNTY HMA LLC
Entity Type:Organization
Organization Name:CAMPBELL COUNTY HMA LLC
Other - Org Name:TENNOVA PRIMARY CARE CLINTON
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:629-215-3953
Mailing Address - Street 1:2200 N CHARLES G SEIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-6738
Mailing Address - Country:US
Mailing Address - Phone:423-566-6872
Mailing Address - Fax:423-566-6871
Practice Address - Street 1:2200 N CHARLES G SEIVERS BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-6738
Practice Address - Country:US
Practice Address - Phone:423-566-6872
Practice Address - Fax:423-566-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health