Provider Demographics
| NPI: | 1275531956 |
|---|---|
| Name: | COOKEVILLE REGIONAL MEDICAL CENTER |
| Entity Type: | Organization |
| Organization Name: | COOKEVILLE REGIONAL MEDICAL CENTER |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | MARILYN |
| Authorized Official - Middle Name: | C |
| Authorized Official - Last Name: | KEY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 931-783-2481 |
| Mailing Address - Street 1: | 1 MEDICAL CENTER BLVD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | COOKEVILLE |
| Mailing Address - State: | TN |
| Mailing Address - Zip Code: | 38501-1760 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 931-783-2602 |
| Mailing Address - Fax: | 931-783-5666 |
| Practice Address - Street 1: | 1 MEDICAL CENTER BLVD |
| Practice Address - Street 2: | |
| Practice Address - City: | COOKEVILLE |
| Practice Address - State: | TN |
| Practice Address - Zip Code: | 38501-1760 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 931-783-2602 |
| Practice Address - Fax: | 931-783-5666 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-07-07 |
| Last Update Date: | 2023-06-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| TN | 0000000095 | 282N00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 282N00000X | Hospitals | General Acute Care Hospital |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TN | 0064651 | Other | AETNA PROVIDER ID # |
| TN | 369883 | Other | AMERICHOICE PIN # FOR PROFESSIONAL BILING |
| TN | 3870577 | Other | AMERIGROUP PIN # FOR PROFESSIONAL BILLING |
| TN | 4109479 | Other | BCBST&TNCARE PIN PROF FEE |
| TN | 27478 | Other | AMERIGROUP PIN # FOR PROFESSIONAL BILLING |
| TN | 3088600 | Other | BCBST&TNCARE PIN PROF FEE |
| TN | 4088879 | Other | BCBST&TNCARE PIN PROF FEE |
| TN | 3071971 | Other | AMERIGROUP PIN # FOR PROFESSIONAL BILLING |
| TN | 3091395 | Other | AMERIGROUP PIN # FOR PROFESSIONAL BILLING |
| TN | 369882 | Other | AMERICHOICE PIN # FOR PROFESSIONAL BILLING |
| TN | 4123672 | Other | BCBST&TNCARE PIN PROF FEE |
| TN | 4139913 | Other | BCBST&TNCARE PIN PROF FEE |
| TN | TN0104 | Other | AMERICHOICE PIN # FOR PROFESSIONAL BILLING |
| TN | 1000116 | Other | TENNCARE PROVIDER ID # |
| TN | 3064481 | Other | AMERIGROUP PIN # FOR PROFESSIONAL BILLING |
| TN | 3088599 | Other | BCBST&TNCARE PIN PROF FEE |
| TN | 3806863 | Other | AMERIGROUP PIN # FOR PROFESSIONAL BILLING |
| TN | 4042505 | Other | BCBST&TNCARE PIN PROF FEE |
| TN | 3079003 | Other | BCBST&TNCARE PIN PROF FEE |
| TN | 3163698 | Other | BCBST&TNCARE PIN PROF FEE |
| TN | 3894633 | Other | AMERIGROUP PIN # FOR PROFESSIONAL BILLING |
| TN | 4119802 | Other | BCBST&TNCARE PIN PROF FEE |
| TN | 0440059 | Medicaid | |
| TN | 1000116 | Other | BLUE CROSS PROVIDER # |
| TN | 3836719 | Other | AMERIGROUP PIN # FOR PROFESSIONAL BILLING |
| TN | 3067323 | Other | AMERIGROUP PIN # FOR PROFESSIONAL BILLING |
| TN | 5000408 | Other | UHC PROVIDER ID # |
| TN | 3836719 | Other | AMERIGROUP PIN # FOR PROFESSIONAL BILLING |
| TN | 4139913 | Other | BCBST&TNCARE PIN PROF FEE |
