Provider Demographics
NPI:1407827157
Name:MCKENZIE TENNESSEE HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:MCKENZIE TENNESSEE HOSPITAL COMPANY LLC
Other - Org Name:MCKENZIE REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP, GROUP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-373-9600
Mailing Address - Street 1:PO BOX 501092
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-1092
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:161 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-1636
Practice Address - Country:US
Practice Address - Phone:731-352-5344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000011282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN25796Medicaid
TN440008Medicaid
4050785OtherBCBS
TN136768Medicaid
TN26664Medicaid
TN0440182Medicaid
TN26664Medicaid
TN0440182Medicaid