Provider Demographics
NPI:1689160939
Name:MAURY REGIONAL HOSPITAL
Entity type:Organization
Organization Name:MAURY REGIONAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-490-7019
Mailing Address - Street 1:PO BOX 100054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30348-0054
Mailing Address - Country:US
Mailing Address - Phone:931-796-4901
Mailing Address - Fax:
Practice Address - Street 1:98 EXPERIMENT STATION LANE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4700
Practice Address - Country:US
Practice Address - Phone:931-796-4901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAURY REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-10
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)