Provider Demographics
NPI:1891776217
Name:JEFFERSON COUNTY HMA, LLC
Entity Type:Organization
Organization Name:JEFFERSON COUNTY HMA, LLC
Other - Org Name:TENNOVA HEALTHCARE-JEFFERSON MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:110 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-5281
Mailing Address - Country:US
Mailing Address - Phone:865-471-2500
Mailing Address - Fax:865-471-2450
Practice Address - Street 1:110 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5281
Practice Address - Country:US
Practice Address - Phone:865-471-2500
Practice Address - Fax:865-471-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000038275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN044U056Medicaid
TN44U056Medicare Oscar/Certification