Provider Demographics
NPI:1881642841
Name:SP ACQUISITION CORP.
Entity Type:Organization
Organization Name:SP ACQUISITION CORP.
Other - Org Name:GRANDVIEW MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:S
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 1:1000 HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3638
Mailing Address - Country:US
Mailing Address - Phone:423-837-9500
Mailing Address - Fax:423-837-3333
Practice Address - Street 1:1000 HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3638
Practice Address - Country:US
Practice Address - Phone:423-837-9500
Practice Address - Fax:423-837-3333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SP ACQUISITION CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-04
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002180273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN044S064Medicaid
TN1000083Medicaid
TN222276000Medicaid
TN4022166OtherMAGELLAN BC
TN4022166OtherMAGELLAN BC