Provider Demographics
NPI:1881642809
Name:RIVER PARK HOSPITAL LLC
Entity Type:Organization
Organization Name:RIVER PARK HOSPITAL LLC
Other - Org Name:RIVER PARK HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELTON
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-764-3009
Mailing Address - Street 1:1559 SPARTA ST
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1316
Mailing Address - Country:US
Mailing Address - Phone:931-815-4000
Mailing Address - Fax:931-815-4710
Practice Address - Street 1:1559 SPARTA ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1316
Practice Address - Country:US
Practice Address - Phone:931-815-4000
Practice Address - Fax:931-815-4710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002909282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALRIV015NMedicaid
TN1000162Medicaid
ALRIV015NMedicaid