Organization
JELLICO COMMUNITY HOSPITAL, INC
Active
Organization
JELLICO COMMUNITY HOSPITAL, INC
Active
Other names
Care Plus Center
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYN GHULAM (CONTROLLER)
(423) 784-1334
Entity
Organization
Contact information
Practice address
998 SOUTH HIGHWAY 25W, WILLAIMSBURG, KY 40769
(606) 549-1183
(606) 549-8107
Mailing address
188 HOSPITAL LANE, JELLICO, TN 37762-4433
(423) 784-7252
(423) 784-1136
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363AM0700X
Medical Physician Assistant
PA071
KY
363L00000X
Nurse Practitioner
3002560
KY
363L00000X
Nurse Practitioner
3004431
KY
363L00000X
Nurse Practitioner
3007739
KY
Other
Enumeration date
03/09/2011
Last updated
03/10/2016
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