Provider Demographics
NPI:1659326700
Name:CLARKSVILLE HEALTH SYSTEM GP
Entity Type:Organization
Organization Name:CLARKSVILLE HEALTH SYSTEM GP
Other - Org Name:TENNOVA HEALTHCARE-CLARKSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:PO BOX 403765
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3765
Mailing Address - Country:US
Mailing Address - Phone:931-552-6622
Mailing Address - Fax:931-551-1027
Practice Address - Street 1:651 DUNLOP LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5015
Practice Address - Country:US
Practice Address - Phone:931-502-1000
Practice Address - Fax:931-502-1215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARKSVILLE HEALTH SYSTEM GP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000000090273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1000156Medicaid
44T035Medicare Oscar/Certification