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Organization
JELLICO COMMUNITY HOSPITAL INC.
Active
Organization
JELLICO COMMUNITY HOSPITAL INC.
Active
Other names
Jellico Community Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYN GHULAM (CONTROLLER)
(423) 784-1334
Entity
Organization
Contact information
Practice address
188 HOSPITAL LAN, JELLICO, TN 37762-4400
(423) 784-1334
(423) 784-1136
Mailing address
PO BOX 844869, DALLAS, TX 75284-4869
(423) 784-1334
(423) 784-1336
Taxonomy
Speciality
Code
Description
License number
State
282NR1301X
Rural Acute Care Hospital
Primary
0000000007
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0440180
—
TN
01
—
1000250
BLUE CROSS BLUE SHIELD TN
TN
01
—
1530476
UNITED MINE WORKERS
TN
05
—
162084800
—
KY
01
—
397905000
FEDERAL BLACK LUNG
TN
01
—
440180
MEDICARE MANAGED CARE
TN
01
—
450003829
KY MEDICAID EPSDT
TN
01
—
54976
ANTHEM BLUE CROSS
TN
01
—
55620496
UNISYS AMBULANCE
TN
01
—
6530360
AETNA
TN
01
—
A3776201
TC AMBULANCE
TN
Enumeration date
07/29/2006
Last updated
06/07/2016
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