Provider Demographics
NPI:1093760712
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:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:436 CENTRAL AVE W
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-3031
Mailing Address - Country:US
Mailing Address - Phone:931-879-8171
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000048282N00000X
367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1000102OtherBLUE CROSS
TN0440083Medicaid
440083Medicare Oscar/Certification
TN3278955Medicare PIN