Provider Demographics
NPI:1366423782
Name:ST. MARY'S MEDICAL CENTER OF CAMPBELL COUNTY, INC.
Entity type:Organization
Organization Name:ST. MARY'S MEDICAL CENTER OF CAMPBELL COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP AND GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-552-3458
Mailing Address - Street 1:923 EAST CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAFOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2055
Mailing Address - Country:US
Mailing Address - Phone:423-907-1200
Mailing Address - Fax:423-907-1164
Practice Address - Street 1:923 EAST CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAFOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2055
Practice Address - Country:US
Practice Address - Phone:423-907-1200
Practice Address - Fax:423-907-1164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH PARTNERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-11
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000008282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3250161Medicare PIN