Provider Demographics
NPI:1518957174
Name:ROANE MEDICAL CENTER
Entity Type:Organization
Organization Name:ROANE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-882-4377
Mailing Address - Street 1:512 DEVONIA ST
Mailing Address - Street 2:P.O. BOX 489
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-2115
Mailing Address - Country:US
Mailing Address - Phone:865-882-1323
Mailing Address - Fax:865-882-4463
Practice Address - Street 1:512 DEVONIA ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2115
Practice Address - Country:US
Practice Address - Phone:865-882-1323
Practice Address - Fax:865-882-4463
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-25
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN98282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0440031Medicaid
TN440031Medicare ID - Type UnspecifiedPROVIDER NUMBER
TN440031Medicare Oscar/Certification