Organization
STATE OF TENNESSEE-WESTERN MENTAL HEALTH INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD B TAYLOR (FISCAL DIRECTOR)
(731) 228-2044
Entity
Organization
Contact information
Practice address
11100 HIGHWAY 64, BOLIVAR, TN 38008-1554
(731) 228-2000
(731) 658-9822
Mailing address
11100 HIGHWAY 64, BOLIVAR, TN 38008-1554
(731) 228-2000
(731) 658-9822
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
L216-075-1114
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10796/2003053
BLUE CROSS/BLUE SHIELD
TN
05
—
444008/3282236
—
TN
Enumeration date
05/23/2006
Last updated
08/22/2020
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