Provider Demographics
NPI:1346213642
Name:COCKE COUNTY HMA LLC
Entity type:Organization
Organization Name:COCKE COUNTY HMA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUFFINGTON-PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-282-2943
Mailing Address - Street 1:450 COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3752
Mailing Address - Country:US
Mailing Address - Phone:435-625-2105
Mailing Address - Fax:
Practice Address - Street 1:450 COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3752
Practice Address - Country:US
Practice Address - Phone:435-625-2105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440369Medicaid