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
TC AMBULANCE
TN
01
—
450003829
KY MEDICAID EPSDT
TN
01
—
54976
ONE NATION OLD ANTHEM BE
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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