Provider Demographics
NPI:1023251923
Name:CLAIBORNE COUNTY HOSPITAL CLAIBORNE COUNTY AMBULANCE
Entity type:Organization
Organization Name:CLAIBORNE COUNTY HOSPITAL CLAIBORNE COUNTY AMBULANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-626-4211
Mailing Address - Street 1:1850 OLD KNOXVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-3625
Mailing Address - Country:US
Mailing Address - Phone:423-626-4211
Mailing Address - Fax:423-626-9926
Practice Address - Street 1:1850 OLD KNOXVILLE RD
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3625
Practice Address - Country:US
Practice Address - Phone:423-626-4211
Practice Address - Fax:423-626-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0440057Medicaid
TN0440057Medicaid