Provider Demographics
NPI:1629082466
Name:FRANK T RUTHERFORD MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:FRANK T RUTHERFORD MEMORIAL HOSPITAL, INC
Other - Org Name:RIVERVIEW REGIONAL MEDICAL CENTER SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHOITE
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 1:130 LEBANON HWY
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-2955
Practice Address - Country:US
Practice Address - Phone:615-735-9815
Practice Address - Fax:615-735-3062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANK T RUTHERFORD MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000129282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN044Z307Medicaid
TN44Z307OtherHUMANA CHOICE MCR ADV
TN83656OtherBLUE CROSS
TN=========010OtherCHAMPUS
TN044Z307Medicaid