Basic Information
| Provider Information | |||||||||
| NPI: | 1982874129 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MORRISTOWN HAMBLEN HOSP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MORRISTOWN INPATIENT SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 888043 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379958043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656706199 | ||||||||
| FaxNumber: | 8656706158 | ||||||||
| Practice Location | |||||||||
| Address1: | 908 W 4TH NORTH ST | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378143894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235224390 | ||||||||
| FaxNumber: | 4235853399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2008 | ||||||||
| LastUpdateDate: | 04/30/2012 | ||||||||
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| AuthorizedOfficialLastName: | BIGGD | ||||||||
| AuthorizedOfficialFirstName: | JEREMY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CAO | ||||||||
| AuthorizedOfficialTelephone: | 4235224390 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1504854 | 05 | TN | MEDICAID |