Provider Demographics
NPI:1497983803
Name:HMA FENTRESS COUNTY GENERAL HOSPITAL INC
Entity Type:Organization
Organization Name:HMA FENTRESS COUNTY GENERAL HOSPITAL INC
Other - Org Name:JAMESTOWN REGIONAL CRNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP AND GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:239-598-3111
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-0803
Mailing Address - Country:US
Mailing Address - Phone:931-879-8171
Mailing Address - Fax:
Practice Address - Street 1:436 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3031
Practice Address - Country:US
Practice Address - Phone:931-879-8171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0440083Medicaid