Provider Demographics
NPI:1821274481
Name:ROANE COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:ROANE COUNTY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALL-PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-882-8856
Mailing Address - Street 1:PO BOX 1646
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-1646
Mailing Address - Country:US
Mailing Address - Phone:865-882-4440
Mailing Address - Fax:865-882-4447
Practice Address - Street 1:319 DEVONIA ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2008
Practice Address - Country:US
Practice Address - Phone:865-882-4440
Practice Address - Fax:865-882-4447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-14
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000039251041C0700X
TNMD42907207R00000X
TNMD39076207RI0200X
TN00000196652084P0800X
TN00000261232084P0800X
TN00000390002084P0800X
TN0000000098282N00000X
TN0000077192364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
No364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, GeropsychiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3258304Medicare PIN
TN3373633Medicare PIN