Provider Demographics
NPI:1487716890
Name:SHELBYVILLE HOSPITAL CORPORATION
Entity type:Organization
Organization Name:SHELBYVILLE HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMBARDI-MOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:931-389-0600
Mailing Address - Street 1:PO BOX 403621
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3621
Mailing Address - Country:US
Mailing Address - Phone:931-389-0600
Mailing Address - Fax:931-389-6781
Practice Address - Street 1:507 BLACKMAN BLVD W
Practice Address - Street 2:
Practice Address - City:WARTRACE
Practice Address - State:TN
Practice Address - Zip Code:37183-2210
Practice Address - Country:US
Practice Address - Phone:931-389-0600
Practice Address - Fax:931-389-6781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELBYVILLE HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty