Provider Demographics
NPI:1386865673
Name:CLAIBORNE MEDICAL CENTER
Entity Type:Organization
Organization Name:CLAIBORNE MEDICAL CENTER
Other - Org Name:CLAIBORNE COUNTY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:GEPPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-374-6864
Mailing Address - Street 1:1420 CENTERPOINT BLVD BLDG C
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1960
Mailing Address - Country:US
Mailing Address - Phone:865-374-6864
Mailing Address - Fax:865-374-6926
Practice Address - Street 1:1850 OLD KNOXVILLE RD
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3625
Practice Address - Country:US
Practice Address - Phone:423-626-4211
Practice Address - Fax:423-626-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000040313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440036Medicaid