Provider Demographics
NPI:1245275254
Name:SAINT THOMAS HICKMAN HOSPITAL
Entity type:Organization
Organization Name:SAINT THOMAS HICKMAN HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-729-6790
Mailing Address - Street 1:135 E SWAN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-1417
Mailing Address - Country:US
Mailing Address - Phone:931-729-4271
Mailing Address - Fax:931-729-0174
Practice Address - Street 1:135 E SWAN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-1417
Practice Address - Country:US
Practice Address - Phone:931-729-4271
Practice Address - Fax:931-729-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X
TN0000000056282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3280568OtherMEDICARE PTAN
TN0441300Medicaid
TN1000133OtherBLUE CROSS
TN441300OtherMEDICARE INPATIENT
TN44Z300OtherMEDICARE SWINGBED
TN044Z300Medicaid