Provider Demographics
NPI:1275505372
Name:MARTIN HEALTH
Entity Type:Organization
Organization Name:MARTIN HEALTH
Other - Org Name:WEST TENNESSEE HEALTHCARE VOLUNTEER HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-541-6731
Mailing Address - Street 1:161 MOUNT PELIA RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3811
Mailing Address - Country:US
Mailing Address - Phone:731-587-4261
Mailing Address - Fax:731-588-3209
Practice Address - Street 1:161 MOUNT PELIA RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3811
Practice Address - Country:US
Practice Address - Phone:731-587-4261
Practice Address - Fax:731-588-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000126282N00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01600824Medicaid
TN0440061Medicaid
TN25795Medicaid
TN136771Medicaid
421557527OtherCHAMPUS
TN044-0061Medicaid
4048507OtherBCBS