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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