Provider Demographics
NPI:1225049570
Name:HICKMAN COMMUNITY HEALTH CARESERVICES
Entity Type:Organization
Organization Name:HICKMAN COMMUNITY HEALTH CARESERVICES
Other - Org Name:HICKMAN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-729-6779
Mailing Address - Street 1:5047 HIGHWAY 100
Mailing Address - Street 2:
Mailing Address - City:LYLES
Mailing Address - State:TN
Mailing Address - Zip Code:37098-1878
Mailing Address - Country:US
Mailing Address - Phone:931-670-6525
Mailing Address - Fax:931-670-6527
Practice Address - Street 1:5047 HIGHWAY 100
Practice Address - Street 2:
Practice Address - City:LYLES
Practice Address - State:TN
Practice Address - Zip Code:37098-1878
Practice Address - Country:US
Practice Address - Phone:931-670-6525
Practice Address - Fax:931-670-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0443436Medicaid
TN4057061OtherBCBS
TN4057061OtherBCBS
TN443436Medicare PIN