Provider Demographics
NPI:1528665452
Name:MAURY REGIONAL HOSPITAL
Entity type:Organization
Organization Name:MAURY REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BRATTON
Authorized Official - Last Name:BETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-759-7147
Mailing Address - Street 1:103 JV MANGUBAT DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-2440
Mailing Address - Country:US
Mailing Address - Phone:952-653-2525
Mailing Address - Fax:952-653-2540
Practice Address - Street 1:103 JV MANGUBAT DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2440
Practice Address - Country:US
Practice Address - Phone:952-653-2525
Practice Address - Fax:952-653-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site