# JELLICO COMMUNITY HOSPITAL, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jellico Community Hospital Wound Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073898714
- **Authorized official:** EVELYN GHULAM (CONTROLLER)
- **Authorized official phone:** (423) 784-1334

## Contact information

- **Practice address:** 188 HOSPITAL LN, JELLICO, TN 37762-4400
- **Practice address phone:** (423) 784-1272
- **Practice address fax:** (423) 784-1136
- **Mailing address:** 188 HOSPITAL LN, JELLICO, TN 37762-4400
- **Mailing address phone:** (423) 784-1272
- **Mailing address fax:** (423) 784-1136

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/13/2011
- **Last updated:** 03/10/2016