Provider Demographics
NPI:1710535703
Name:PERRY COUNTY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:PERRY COUNTY MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-589-2104
Mailing Address - Street 1:PO BOX 916
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-0916
Mailing Address - Country:US
Mailing Address - Phone:931-589-2104
Mailing Address - Fax:
Practice Address - Street 1:7723 CLEARVIEW CHURCH LN STE 200
Practice Address - Street 2:
Practice Address - City:LYLES
Practice Address - State:TN
Practice Address - Zip Code:37098-1674
Practice Address - Country:US
Practice Address - Phone:931-670-8318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THREE RIVERS COMMUNITY HEALTH GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-03
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty