Provider Demographics
NPI:1194378083
Name:MAURY REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:MAURY REGIONAL HOSPITAL
Other - Org Name:COLUMBIA OB GYN PRIMARY CARE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-490-7019
Mailing Address - Street 1:617 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462-1355
Mailing Address - Country:US
Mailing Address - Phone:931-796-4901
Mailing Address - Fax:
Practice Address - Street 1:1222 TROTWOOD AVE STE 603
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6410
Practice Address - Country:US
Practice Address - Phone:931-490-1295
Practice Address - Fax:931-490-1298
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAURY REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-19
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care