Provider Demographics
NPI:1821619560
Name:TAKOMA REGIONAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:TAKOMA REGIONAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILGOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-431-5794
Mailing Address - Street 1:509 MED TECH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2579
Mailing Address - Country:US
Mailing Address - Phone:423-952-2111
Mailing Address - Fax:423-952-2175
Practice Address - Street 1:1021 COOLIDGE ST STE 5
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4692
Practice Address - Country:US
Practice Address - Phone:423-636-0700
Practice Address - Fax:423-224-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center