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

Similar Providers

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

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
1 NPI 1790756203
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name CLEVELAND TENNESSEE HOSPITAL COMPANY LLC
5 Provider Other Organization Name SKYRIDGE MEDICAL CENTER WESTSIDE CAMPUS
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 2305 CHAMBLISS AVE NW
8 Provider Business Practice Location Address City Name CLEVELAND
9 Provider Business Practice Location Address State Name TN
10 Provider Business Practice Location Address Postal Code 373113847
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 4235596000
13 Provider Business Practice Location Address Fax Number 4235596653
14 Provider Enumeration Date 2/1/2006
15 Last Update Date 10/8/2009
16 Authorized Official Last Name HOLTSFORD
17 Authorized Official First Name LAURIE
18 Authorized Official Title or Position AUTHORIZIED OFFICIAL / DIRECTOR
19 Authorized Official Telephone Number 6154657466
20 Healthcare Provider Taxonomy Code 1 282N00000X
21 Provider License Number 1 0000000006
22 Provider License Number State Code 1 TN
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Other Provider Identifier 1 0140006296
25 Other Provider Identifier Type Code 1 01
26 Other Provider Identifier Issuer 1 HEALTHSOURCE
27 Other Provider Identifier 2 0440185
28 Other Provider Identifier Type Code 2 05
29 Other Provider Identifier State 2 TN
30 Other Provider Identifier 3 01CCHTN
31 Other Provider Identifier Type Code 3 01
32 Other Provider Identifier Issuer 3 COMP HEALTH
33 Other Provider Identifier 4 1000017
34 Other Provider Identifier Type Code 4 01
35 Other Provider Identifier Issuer 4 BCBS
36 Other Provider Identifier 5 A3731201
37 Other Provider Identifier Type Code 5 01
38 Other Provider Identifier Issuer 5 JOHN DEERE
39 Other Provider Identifier 6 00136133A
40 Other Provider Identifier Type Code 6 05
41 Other Provider Identifier State 6 GA
42 Other Provider Identifier 7 440185
43 Other Provider Identifier Type Code 7 06
44 Other Provider Identifier State 7 TN
45 Other Provider Identifier 8 5000072
46 Other Provider Identifier Type Code 8 01
47 Other Provider Identifier Issuer 8 UNITED HEALTHCARE
48 Other Provider Identifier 9 030433100
49 Other Provider Identifier Type Code 9 01
50 Other Provider Identifier Issuer 9 BLACK LUNG
51 Is Organization Subpart N

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This page was last updated on: 10/12/2014
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