Provider Demographics
NPI:1861538308
Name:UNICOI COUNTY MEMORIAL HOSPITAL INC
Entity type:Organization
Organization Name:UNICOI COUNTY MEMORIAL HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR PHCY SVCS
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-743-1272
Mailing Address - Street 1:100 GREENWAY CIR
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-2177
Mailing Address - Country:US
Mailing Address - Phone:423-743-1229
Mailing Address - Fax:423-743-2816
Practice Address - Street 1:100 GREENWAY CIR
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-2177
Practice Address - Country:US
Practice Address - Phone:423-743-1229
Practice Address - Fax:423-743-2816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336I0012X
TN13743336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4414087OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN0445077Medicaid
TN7440197Medicaid