Provider Demographics
NPI:1225092547
Name:HOHENWALD MEDICAL CENTER
Entity Type:Organization
Organization Name:HOHENWALD MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-796-7960
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462-0005
Mailing Address - Country:US
Mailing Address - Phone:931-796-7960
Mailing Address - Fax:931-796-7790
Practice Address - Street 1:20 S PARK ST
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-1413
Practice Address - Country:US
Practice Address - Phone:931-796-7960
Practice Address - Fax:931-796-7790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000021337207Q00000X
TNPA0000000781363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3715488Medicaid
TN4058796OtherBC/BS OF TENNESSEE
TNTN0101OtherAMERICHOICE
TN4058796OtherBC/BS OF TENNESSEE