Provider Demographics
NPI:1528057791
Name:MAURY REGIONAL HOSPITAL
Entity type:Organization
Organization Name:MAURY REGIONAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRINKLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:931-540-4212
Mailing Address - Street 1:858 W JAMES M CAMPBELL BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4660
Mailing Address - Country:US
Mailing Address - Phone:931-490-4600
Mailing Address - Fax:931-380-4103
Practice Address - Street 1:800 S JAMES M CAMPBELL BLVD STE 12
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-5937
Practice Address - Country:US
Practice Address - Phone:931-490-4600
Practice Address - Fax:931-380-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000180251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0447408Medicaid
TN39322OtherBLUE CROSS BLUE SHIELD NO
TN0447408Medicaid