JELLICO COMMUNITY HOSPITAL INC. (NPI# 1699794578) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699794578 |
| Entity Type | Organization |
| Organization Name | JELLICO COMMUNITY HOSPITAL INC. |
| Other Organization Name | JELLICO COMMUNITY HOSPITAL |
| Practice Address |
188 Hospital Lane Jellico TN 37762-4400 |
| Mailing Address |
Po Box 844869 Dallas TX 75284-4869 |
| Practice Telephone | 4237841334 |
| Practice Fax Number | 4237841136 |
| Mailing Telephone | 4237841334 |
| Mailing Fax Number | 4237841336 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2016-06-07 |
| 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 | 275N00000X | Medicare Defined Swing Bed Unit | 0000000007 | TN | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | TC AMBULANCE | A3776201 | 01 |
| TN | TC AMBULANCE | 1000250 | 01 |
| TN | FEDERAL BLACK LUNG | 397905000 | 01 |
| TN | 0440180 | 05 | |
| TN | UNITED MINE WORKERS | 1530476 | 01 |
| TN | MEDICARE MANAGED CARE | 440180 | 01 |
| TN | ANTHEM BLUE CROSS | 54976 | 01 |
| TN | AETNA | 6530360 | 01 |
| KY | 01620848 | 05 | |
| TN | BLUE CROSS BLUE SHIELD | 1000250 | 01 |
| TN | TC AMBULANCE | 440180 | 01 |
| TN | JOHN DEERE COMMERCIAL | A3776201 | 01 |
| TN | UNISYS AMBULANCE | 55620496 | 01 |
| Other Name | Type Code |
|---|---|
| Jellico Community Hospital | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588679898 | Jellico Community Hospital Inc. | General Acute Care Hospital | 188 Hospital Lan, Jellico, TN 37762-4400 | 2006-07-29 |
| 1699296673 | Jellico Community Hospital Inc. | Clinic/Center | 19268 Alberta St, Oneida, TN 37841-6061 | 2017-06-29 |
| 1972674851 | Jellico Community Hospital Inc. | Nurse Anesthetist, Certified Registered | 188 Hospital Lan, Jellico, TN 37762-4400 | 2006-11-13 |
| Street Address |
188 HOSPITAL LANE |
| City | JELLICO |
| State | TN |
| Zip Code | 37762-4400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225096217 | Benjamin Wayne D'ooge | Emergency Medicine | 188 Hospital Lane, Jellico, TN 37762 | 2006-05-02 |
| 1548580046 | Jellico Community Hospital, Inc | Skilled Nursing Facility | 188 Hospital Lane, Jellico, TN 37762-4400 | 2010-06-07 |
| 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 |
| 1770790065 | Dayspring Health Inc | Physician Assistant | 107 S Main St, Jellico, TN 37762 | 2007-05-17 |
| 1790856102 | Charles R Hayes | Nurse Anesthetist, Certified Registered | 188 Hospital Ln, Jellico, TN 37762 | 2006-11-10 |
| 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 | 275N00000X |
| Grouping | Hospital Units |
| Classification | Medicare Defined Swing Bed Unit |
| A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit. |
| Notes: Source: Code of Federal Regulations #42, Section 482.66. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134655731 | West Tennessee Rehabilitation Hospital, LLC | Medicare Defined Swing Bed Unit | 180 Mount Pelia Road, Martin, TN 38237 | 2017-05-03 |
| 1073622007 | Chattanooga Hamilton County Hospital Authority | Medicare Defined Swing Bed Unit | 71 Wheelertown Avenue, Pikeville, TN 37367 | 2006-08-30 |
| 1598734352 | Rebound LLC | Medicare Defined Swing Bed Unit | 190 Mount Pelia Rd, Martin, TN 38237-3812 | 2006-03-15 |
| 1821060930 | Martin Health | Medicare Defined Swing Bed Unit | 161 Mount Pelia Rd, Martin, TN 38237-3811 | 2006-02-02 |
| 1518957950 | Bolivar General Hospital, Inc. | Medicare Defined Swing Bed Unit | 650 Nuckolls Rd, Bolivar, TN 38008-1532 | 2005-10-26 |
| 1952900920 | Vanderbilt Bedford Hospital, LLC | Medicare Defined Swing Bed Unit | 2835 Highway 231 N, Shelbyville, TN 37160-7327 | 2020-10-21 |
| 1750904041 | Tullahoma Hma LLC | Medicare Defined Swing Bed Unit | 1801 N Jackson St, Tullahoma, TN 37388-8259 | 2020-05-21 |
| 1427671718 | Clarksville Health System Gp | Medicare Defined Swing Bed Unit | 651 Dunlop Ln, Clarksville, TN 37040-5015 | 2020-05-21 |
| 1518580893 | Cleveland Tennessee Hospital Company LLC | Medicare Defined Swing Bed Unit | 2305 Chambliss Ave Nw, Cleveland, TN 37311-3847 | 2020-05-21 |
| 1417570961 | Metro Knoxville Hma LLC | Medicare Defined Swing Bed Unit | 7565 Dannaher Dr, Powell, TN 37849-4029 | 2020-05-19 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on JELLICO COMMUNITY HOSPITAL INC..
| 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.