Provider Demographics
NPI:1316190069
Name:ROANE COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:ROANE COUNTY MEDICAL CENTER
Other - Org Name:EMORY RIVER GERIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF THE BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-882-1323
Mailing Address - Street 1:412 DEVONIA ST
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-2009
Mailing Address - Country:US
Mailing Address - Phone:865-882-1323
Mailing Address - Fax:865-882-4343
Practice Address - Street 1:412 DEVONIA ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2009
Practice Address - Country:US
Practice Address - Phone:865-882-1323
Practice Address - Fax:865-882-4343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROANE COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-28
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000098273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44S031Medicare Oscar/Certification