Provider Demographics
NPI:1790834430
Name:HARDIN COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:HARDIN COUNTY GENERAL HOSPITAL
Other - Org Name:HMC HOME SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-926-8000
Mailing Address - Street 1:925 PICKWICK ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-3057
Mailing Address - Country:US
Mailing Address - Phone:731-926-8212
Mailing Address - Fax:731-926-8213
Practice Address - Street 1:925 PICKWICK ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-3057
Practice Address - Country:US
Practice Address - Phone:731-926-8212
Practice Address - Fax:731-926-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000449332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452234Medicaid
TN1452234Medicaid