JELLICO COMMUNITY HOSPITAL, INC (NPI# 1073898714) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073898714 |
| Entity Type | Organization |
| Organization Name | JELLICO COMMUNITY HOSPITAL, INC |
| Other Organization Name | JELLICO COMMUNITY HOSPITAL WOUND CARE CENTER |
| Practice Address |
188 Hospital Ln Jellico TN 37762-4400 |
| Practice Telephone | 4237841272 |
| Practice Fax Number | 4237841136 |
| Mailing Telephone | 4237841272 |
| Mailing Fax Number | 4237841136 |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2016-03-10 |
| Authorized Official Name | EVELYN GHULAM (CONTROLLER) |
| Authorized Official Telephone | 4237841334 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Jellico Community Hospital Wound Care Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407154800 | Jellico Community Hospital, Inc | Nurse Practitioner | 998 South Highway 25w, Willaimsburg, KY 40769 | 2011-03-09 |
| 1548580046 | Jellico Community Hospital, Inc | Skilled Nursing Facility | 188 Hospital Lane, Jellico, TN 37762-4400 | 2010-06-07 |
| 1891952248 | Jellico Community Hospital, Inc | Rehabilitation Unit | 998 S Highway 25 W, Williamsburg, KY 40769-1692 | 2008-05-21 |
| Street Address |
188 HOSPITAL LN |
| City | JELLICO |
| State | TN |
| Zip Code | 37762-4400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255300182 | Terrence Wesley Leveck | Emergency Medicine | 188 Hospital Ln, Jellico Community Hospital, Jellico, TN 37762-4400 | 2006-03-14 |
| 1083171664 | Jellico Medical Center, Inc. | General Acute Care Hospital | 188 Hospital Ln, Jellico, TN 37762-4400 | 2019-03-01 |
| 1497297949 | Jellico Healthcare Associates LLC | Physician Assistant | 188 Hospital Ln, Jellico, TN 37762-4400 | 2016-11-15 |
| 1992253025 | Hcc of Jellico LLC | Internal Medicine | 188 Hospital Ln, Jellico, TN 37762-4400 | 2016-09-19 |
| 1932551041 | Ess of Jellico LLC | Emergency Medicine | 188 Hospital Ln, Jellico, TN 37762-4400 | 2016-07-13 |
| 1528436334 | Shonda Lynn Tucker | Nurse Practitioner | 188 Hospital Ln, Jellico, TN 37762-4400 | 2015-09-10 |
| 1124322847 | Jellico Emergency Physicians Medical Group PC | Emergency Medicine | 188 Hospital Ln, Jellico, TN 37762-4400 | 2011-01-10 |
| 1649442237 | Bishofberger Medical Associates of East Tennessee | Surgery | 188 Hospital Ln, Jellico, TN 37762-4400 | 2008-03-24 |
| 1407024979 | Pine Mountain Emergency Physicians | Emergency Medicine | 188 Hospital Ln, Jellico, TN 37762-4400 | 2008-02-18 |
| 1871774042 | Pedro Pablo Flores | Emergency Medicine | 188 Hospital Ln, Jellico, TN 37762-4400 | 2007-11-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063992600 | Springs of Life | Psychologist | 185 Baker Street, Jellico, TN 37762 | 2018-08-14 |
| 1679666366 | Charles Henry Wilkens | Family Medicine | 131 Hospital Lane, Jellico, TN 37762 | 2006-10-02 |
| 1225096217 | Benjamin Wayne D'ooge | Emergency Medicine | 188 Hospital Lane, Jellico, TN 37762 | 2006-05-02 |
| 1770790065 | Dayspring Health Inc | Physician Assistant | 107 S Main St, Jellico, TN 37762 | 2007-05-17 |
| 1023022084 | Dayspring Health Inc | Obstetrics & Gynecology | 550 Sunset Trl, Jellico, TN 37762 | 2006-07-27 |
| 1174691315 | Family Drug Center Inc | Durable Medical Equipment & Medical Supplies | 248 S Main St, Jellico, TN 37762-2017 | 2006-12-04 |
| 1114442175 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 248 S Main St, Jellico, TN 37762-2017 | 2017-08-10 |
| 1598211401 | Jonathan Broyles | Pharmacist | 248 S Main St, Jellico, TN 37762-2017 | 2016-08-30 |
| 1184008005 | Rite Aid of Tennessee Inc | Durable Medical Equipment & Medical Supplies | 248 S Main St, Jellico, TN 37762-2017 | 2015-07-10 |
| 1134589823 | Walter Stephens | Physical Therapist | 269 S Main St, Jellico, TN 37762-2018 | 2016-02-24 |
| Find all providers in zip 37762 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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| 1609388438 | East Tennessee Children's Hospital Association, Inc. | Clinic/Center | 1060 Peerless Xing Nw Ste 100, Cleveland, TN 37312-3785 | 2017-11-02 |
| 1376095596 | Dr. Andrea's Medical & Weight Loss Clinic, Pllc | Clinic/Center | 8317 Cordova Rd, Suite 201, Cordova, TN 38016-2088 | 2016-11-04 |
| 1316304629 | Deep River Wellness Center | Clinic/Center | 314 Knox Rd, Knoxville, TN 37918-2316 | 2016-01-19 |
| 1417342973 | Sleep Disorders of Tennessee | Clinic/Center | 254 Ren Mar Dr Ste 200, Pleasant View, TN 37146-3723 | 2015-04-01 |
| 1891069555 | Hrc Medical Centers Inc | Clinic/Center | 301 14th Ave N, Nashville, TN 37203-3416 | 2012-02-28 |
| 1801177449 | Mcminn Ortopaedic Clinic, PC | Clinic/Center | 719 Cook Dr Ste 110, Athens, TN 37303-3495 | 2011-09-08 |
| 1104105873 | Swan Urogynecology, PC | Clinic/Center | 329 21st Avenue North, Suite 1, Nashville, TN 37203-1857 | 2011-08-11 |
| 1023304938 | William J Deaton | Clinic/Center | 1462 Wolf Park Rd, Germantown, TN 38138-2354 | 2011-06-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.