Provider Demographics
NPI:1013983030
Name:UNICOI COUNTY MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:UNICOI COUNTY MEMORIAL HOSPITAL INC
Other - Org Name:UNICOI COUNTY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:423-743-3141
Mailing Address - Street 1:100 GREENWAY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650
Mailing Address - Country:US
Mailing Address - Phone:423-743-3141
Mailing Address - Fax:423-743-2890
Practice Address - Street 1:100 GREENWAY CIRCLE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650
Practice Address - Country:US
Practice Address - Phone:423-743-3141
Practice Address - Fax:423-743-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000275313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440197OtherICF
TN0445077Medicaid
TN445077Medicare ID - Type Unspecified