1710215355 NPI number — HIDDEN VALLEY MEDICAL CENTER INC

Table of content: (NPI 1710215355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710215355 NPI number — HIDDEN VALLEY MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIDDEN VALLEY MEDICAL CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
APPALACHIAN PHYSICIANS GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710215355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 689022
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37068-9022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-628-6038
Provider Business Mailing Address Fax Number:
615-465-3007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4799 BLUE RIDGE DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BLUE RIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30513-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-258-4868
Provider Business Practice Location Address Fax Number:
706-258-1165
Provider Enumeration Date:
11/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ARWOOD
Authorized Official First Name:
SOPHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR PHYSICIAN OPERATIONS
Authorized Official Telephone Number:
615-628-6038

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003108331A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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