Provider Demographics
NPI:1770792095
Name:MORRISTOWN HAMBLEN HOSPITAL
Entity type:Organization
Organization Name:MORRISTOWN HAMBLEN HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-522-4439
Mailing Address - Street 1:1621 W MORRIS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2832
Mailing Address - Country:US
Mailing Address - Phone:423-587-2443
Mailing Address - Fax:423-586-9988
Practice Address - Street 1:1621 W MORRIS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2832
Practice Address - Country:US
Practice Address - Phone:423-587-2443
Practice Address - Fax:423-586-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207Q00000X173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3908225Medicaid
TN3644685Medicaid
TN3817771Medicaid
TN3908225Medicaid
3284216Medicare PIN
TN3908225Medicare ID - Type Unspecified
TN3817771Medicare ID - Type Unspecified
TNP92543Medicare UPIN
TN3644685Medicaid
TN3817771Medicaid