# JELLICO COMMUNITY HOSPITAL INC.

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

## Provider details

- **NPI number:** 1588679898
- **Authorized official:** EVELYN GHULAM (CONTROLLER)
- **Authorized official phone:** (423) 784-1334

## Contact information

- **Practice address:** 188 HOSPITAL LAN, JELLICO, TN 37762-4400
- **Practice address phone:** (423) 784-1334
- **Practice address fax:** (423) 784-1136
- **Mailing address:** PO BOX 844869, DALLAS, TX 75284-4869
- **Mailing address phone:** (423) 784-1334
- **Mailing address fax:** (423) 784-1336

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282NR1301X | Rural Acute Care Hospital | 0000000007 | TN | Yes |

## Other

- **Enumeration date:** 07/29/2006
- **Last updated:** 06/07/2016

## 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 |