Provider Demographics
NPI:1104099712
Name:DECATUR COUNTY GENERAL HOSPITAL
Entity type:Organization
Organization Name:DECATUR COUNTY GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCD
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-944-6420
Mailing Address - Street 1:200 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-2038
Mailing Address - Country:US
Mailing Address - Phone:336-944-6420
Mailing Address - Fax:
Practice Address - Street 1:969 TENNESSEE AVE S
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-3700
Practice Address - Country:US
Practice Address - Phone:731-847-3031
Practice Address - Fax:731-847-1122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECATUR COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-04
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000028275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44U070Medicare Oscar/Certification