Provider Demographics
NPI:1427576321
Name:SHELBYVILLE HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:SHELBYVILLE HOSPITAL COMPANY LLC
Other - Org Name:TENNOVA FAMILY CARE-MADISON ST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:1401 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3629
Mailing Address - Country:US
Mailing Address - Phone:931-685-2025
Mailing Address - Fax:931-680-9710
Practice Address - Street 1:1401 MADISON ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3629
Practice Address - Country:US
Practice Address - Phone:931-685-2025
Practice Address - Fax:931-680-9710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELBYVILLE HOSPITAL COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000002261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health