Provider Demographics
NPI:1417086596
Name:HTI MEMORIAL HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:HTI MEMORIAL HOSPITAL CORPORATION
Other - Org Name:TRISTAR SKYLINE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-769-7100
Mailing Address - Street 1:500 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5031
Mailing Address - Country:US
Mailing Address - Phone:615-769-2000
Mailing Address - Fax:615-769-7102
Practice Address - Street 1:500 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5031
Practice Address - Country:US
Practice Address - Phone:615-769-2000
Practice Address - Fax:615-769-7102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HTI MEMORIAL HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
4139992OtherBCBS ADOLESCENT PSYCH
TN136908000OtherTNCARE PREMIER/TBH
TN136908000OtherTNCARE PREMIER/TBH