Provider Demographics
NPI:1518024751
Name:CANNON COUNTY HOSPITAL LLC
Entity Type:Organization
Organization Name:CANNON COUNTY HOSPITAL LLC
Other - Org Name:STONES RIVER HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:Y
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-563-7201
Mailing Address - Street 1:324 DOOLITTLE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1139
Mailing Address - Country:US
Mailing Address - Phone:615-563-7200
Mailing Address - Fax:615-563-7314
Practice Address - Street 1:324 DOOLITTLE RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1139
Practice Address - Country:US
Practice Address - Phone:615-563-7200
Practice Address - Fax:615-563-7314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000009275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44U200Medicare Oscar/Certification