Provider Demographics
NPI:1073765475
Name:HENRY COUNTY MEDICAL CENTER
Entity type:Organization
Organization Name:HENRY COUNTY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-644-8578
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-1030
Mailing Address - Country:US
Mailing Address - Phone:731-642-1220
Mailing Address - Fax:731-642-9588
Practice Address - Street 1:301 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4544
Practice Address - Country:US
Practice Address - Phone:731-642-1220
Practice Address - Fax:731-642-9588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-16
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000057208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3002398Medicaid
TN3002398Medicaid
TN=========OtherEIN