CLEVELAND TENNESSEE HOSPITAL COMPANY LLC (SKYRIDGE MEDICAL CENTER WESTSIDE CAMPUS) - NPI NUMBER 1790756203

Summary

Provider Name: CLEVELAND TENNESSEE HOSPITAL COMPANY LLC (SKYRIDGE MEDICAL CENTER WESTSIDE CAMPUS)

NPI Number: 1790756203

Clasification: General Acute Care Hospital (282N00000X)

Address:
2305 CHAMBLISS AVE NW
CLEVELAND, TN
ZIP 37311

Phone Number: (423) 559-6000



Detailed Information

CLEVELAND TENNESSEE HOSPITAL COMPANY LLC is a general acute care hospital in Cleveland, TN. The provider is an acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. The assigned NPI number for this provider is 1790756203 and is registered as an organization entity type.
The provider Is Doing Business As Skyridge Medical Center Westside Campus.

The provider's business address is:

2305 CHAMBLISS AVE NW
CLEVELAND, TN
ZIP 37311-847
Phone: (423) 559-6000
Fax: (423) 559-6653

The provider's authorized official is Laurie Holtsford .
The authorized official title is Authorizied Official / Director and has the following contact phone number (615) 465-7466.

The enumeration date for this NPI number is 2/1/2006 and was last updated on 10/8/2009.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 282N00000X General Acute Care Hospital 0000000006 TN Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 0140006296 OTHER HEALTHSOURCE
2 0440185 MEDICAID TN
3 01CCHTN OTHER COMP HEALTH
4 1000017 OTHER BCBS
5 A3731201 OTHER JOHN DEERE
6 00136133A MEDICAID GA
7 440185 MEDICARE OSCAR/CERTIFICATION TN
8 5000072 OTHER UNITED HEALTHCARE
9 030433100 OTHER BLACK LUNG

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1790756203 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name CLEVELAND TENNESSEE HOSPITAL COMPANY LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name SKYRIDGE MEDICAL CENTER WESTSIDE CAMPUS Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 2305 CHAMBLISS AVE NW The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name CLEVELAND The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name TN The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 373113847 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 4235596000 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 4235596653 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 2/1/2006 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 10/8/2009 The date that a record was last updated or changed.
16 Authorized Official Last Name HOLTSFORD The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name LAURIE The first name of the authorized official.
18 Authorized Official Title or Position AUTHORIZIED OFFICIAL / DIRECTOR The title or position of the authorized official.
19 Authorized Official Telephone Number 6154657466 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 282N00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Provider License Number 1 0000000006 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
22 Provider License Number State Code 1 TN The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Other Provider Identifier 1 0140006296 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier Type Code 1 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier Issuer 1 HEALTHSOURCE
27 Other Provider Identifier 2 0440185 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier State 2 TN
30 Other Provider Identifier 3 01CCHTN Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier Type Code 3 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
32 Other Provider Identifier Issuer 3 COMP HEALTH
33 Other Provider Identifier 4 1000017 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
34 Other Provider Identifier Type Code 4 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
35 Other Provider Identifier Issuer 4 BCBS
36 Other Provider Identifier 5 A3731201 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
37 Other Provider Identifier Type Code 5 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
38 Other Provider Identifier Issuer 5 JOHN DEERE
39 Other Provider Identifier 6 00136133A Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
40 Other Provider Identifier Type Code 6 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
41 Other Provider Identifier State 6 GA
42 Other Provider Identifier 7 440185 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
43 Other Provider Identifier Type Code 7 06 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
44 Other Provider Identifier State 7 TN
45 Other Provider Identifier 8 5000072 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
46 Other Provider Identifier Type Code 8 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
47 Other Provider Identifier Issuer 8 UNITED HEALTHCARE
48 Other Provider Identifier 9 030433100 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
49 Other Provider Identifier Type Code 9 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
50 Other Provider Identifier Issuer 9 BLACK LUNG
51 Is Organization Subpart N

Similar Providers Nearby

NPI Provider Name NPI Type Taxonomy
1356533475 CLEVELAND FAMILY PHYSICIANS Organization General Acute Care Hospital
1689693293 OCOEE HOSPITAL CORPORATION Organization General Acute Care Hospital
1750363115 COPPER BASIN COMMUNITY HOSPITAL INC Organization General Acute Care Hospital (Critical Access)


Download NPI Record

Download this NPI record in Text format: Export

Download this NPI record in Excel (CSV) format: Export

Download this NPI record in XML format: Export




This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.