Provider Demographics
NPI:1437367802
Name:DYERSBURG HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:DYERSBURG HOSPITAL CORPORATION
Other - Org Name:REGIONAL MEDICAL SUPPLIES OF WEST TENNESSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOREE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-350-0585
Mailing Address - Street 1:1629 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2025
Mailing Address - Country:US
Mailing Address - Phone:731-285-2410
Mailing Address - Fax:
Practice Address - Street 1:1629 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2025
Practice Address - Country:US
Practice Address - Phone:731-285-2410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYERSBURG HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-18
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5954050001Medicare NSC