Provider Demographics
NPI:1578591756
Name:MAURY REGIONAL HOSPITAL MARSHALL MEDICAL CENTER
Entity Type:Organization
Organization Name:MAURY REGIONAL HOSPITAL MARSHALL MEDICAL CENTER
Other - Org Name:MARSHALL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRINKLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:931-540-4212
Mailing Address - Street 1:1080 N ELLINGTON PKWY
Mailing Address - Street 2:P O BOX 1609
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-2227
Mailing Address - Country:US
Mailing Address - Phone:931-359-6241
Mailing Address - Fax:931-270-3627
Practice Address - Street 1:1080 N ELLINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2227
Practice Address - Country:US
Practice Address - Phone:931-359-6241
Practice Address - Fax:931-270-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000075275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0441309Medicaid
TN0410172OtherHEALTHSPRING
TN1000189OtherBLUE CROSS BLUE SHIELD TN
TN1000189OtherTENNCARE SELECT PROVIDER
TN=========OtherTRICARE
TN0410172OtherHEALTHSPRING
TN441309Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER