Provider Demographics
NPI:1750323218
Name:HENDERSONVILLE HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:HENDERSONVILLE HOSPITAL CORPORATION
Other - Org Name:PORTLAND MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-338-1100
Mailing Address - Street 1:PO BOX 277463
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7463
Mailing Address - Country:US
Mailing Address - Phone:615-325-1206
Mailing Address - Fax:615-325-1207
Practice Address - Street 1:105 REDBUD DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1673
Practice Address - Country:US
Practice Address - Phone:615-325-7301
Practice Address - Fax:615-325-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0699930OtherCIGNA
5000036OtherUNITED HEALTHCARE
0063022OtherAETNA
TN1000118OtherTNCARE SELECT
TN1000118OtherBLUE CROSS