Provider Demographics
NPI:1619185428
Name:FRANK T RUTHERFORD MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:FRANK T RUTHERFORD MEMORIAL HOSPITAL, INC
Other - Org Name:RED BOILING SPRINGS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-328-6695
Mailing Address - Street 1:555 HARTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2400
Mailing Address - Country:US
Mailing Address - Phone:615-328-6695
Mailing Address - Fax:615-328-6698
Practice Address - Street 1:718 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:RED BOILING SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37150-2021
Practice Address - Country:US
Practice Address - Phone:615-699-4035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANK T RUTHERFORD MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-18
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000129261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0808599OtherCIGNA
TN443431OtherHUMANA CHOICE MCR ADV
TN1000177OtherBLUE CROSS
TN0443431Medicaid
0808599OtherCIGNA
TN3282272Medicare PIN
=========OtherCOMMERCIAL INS