Provider Demographics
NPI:1780634683
Name:MAURY REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:MAURY REGIONAL HOSPITAL
Other - Org Name:MAURY REGIONAL EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-381-1111
Mailing Address - Street 1:1212 TRADEWINDS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4604
Mailing Address - Country:US
Mailing Address - Phone:931-388-1434
Mailing Address - Fax:931-490-4652
Practice Address - Street 1:1212 TRADEWINDS DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4604
Practice Address - Country:US
Practice Address - Phone:931-388-1434
Practice Address - Fax:931-490-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000060013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3574854Medicare UPIN
TN3574854Medicare ID - Type Unspecified