Provider Demographics
NPI:1326169806
Name:STONES RIVER HOSPITAL
Entity Type:Organization
Organization Name:STONES RIVER HOSPITAL
Other - Org Name:CANNOU COUNTY HOSPITAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHRM MANG
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-563-7233
Mailing Address - Street 1:324 DOOLITTLE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:324 DOOLITTLE RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1139
Practice Address - Country:US
Practice Address - Phone:615-563-7230
Practice Address - Fax:615-563-7234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4103336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4440195OtherOTHER ID NUMBER
4440195OtherOTHER ID NUMBER-COMMERCIAL NUMBER