Provider Demographics
NPI:1639293483
Name:COOKEVILLE REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:COOKEVILLE REGIONAL MEDICAL CENTER
Other - Org Name:COOKEVILLE REGIONAL MEDICAL CENTER INPATIENT REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-783-2481
Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1760
Mailing Address - Country:US
Mailing Address - Phone:931-783-2360
Mailing Address - Fax:931-783-0367
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1760
Practice Address - Country:US
Practice Address - Phone:931-783-2360
Practice Address - Fax:931-783-0367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOKEVILLE REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000095273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10066264OtherAMERIGROUP PIN # FOR INP REBAB UNIT
TN0064651OtherAETNA INP REHAB PIN #
TN044T059Medicaid
TN1000116OtherBCBST INP REHAB PIN #
TN181189OtherBLUECARE TNCARE INP REHAB PIN#
TNA3850101OtherAMERICHOICE PIN # INP REHAB
TN5000408OtherUHC INP REHAB PIN #
TN181189OtherBLUECARE TNCARE INP REHAB PIN#