Provider Demographics
NPI:1285689794
Name:CLARKSVILLE HEALTH SYSTEM GP
Entity Type:Organization
Organization Name:CLARKSVILLE HEALTH SYSTEM GP
Other - Org Name:TENNOVA HEALTHCARE-CLARKSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:PO BOX 403765
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3765
Mailing Address - Country:US
Mailing Address - Phone:931-552-6622
Mailing Address - Fax:931-551-1027
Practice Address - Street 1:651 DUNLOP LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5015
Practice Address - Country:US
Practice Address - Phone:931-502-1000
Practice Address - Fax:931-502-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X, 261QR0206X, 261QR0400X
TN000000090282N00000X
TN147333600000X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1000156Medicaid
440035Medicare Oscar/Certification