Provider Demographics
NPI:1770672628
Name:UNICOI COUNTY MEMORIAL HOSPITAL,INC
Entity Type:Organization
Organization Name:UNICOI COUNTY MEMORIAL HOSPITAL,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-743-3141
Mailing Address - Street 1:100 GREENWAY CIR
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-2177
Mailing Address - Country:US
Mailing Address - Phone:423-743-3141
Mailing Address - Fax:423-743-1244
Practice Address - Street 1:100 GREENWAY CIR
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-2177
Practice Address - Country:US
Practice Address - Phone:423-743-3141
Practice Address - Fax:423-743-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000119332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID
TN=========OtherTAX ID