Provider Demographics
NPI:1881807956
Name:TAKOMA REGIONAL HOSPITAL DBA TAKOMA WOUND CENTER
Entity type:Organization
Organization Name:TAKOMA REGIONAL HOSPITAL DBA TAKOMA WOUND CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-636-2376
Mailing Address - Street 1:401 TAKOMA AVE
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4647
Mailing Address - Country:US
Mailing Address - Phone:423-639-3151
Mailing Address - Fax:423-639-0487
Practice Address - Street 1:401 TAKOMA AVE
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4647
Practice Address - Country:US
Practice Address - Phone:423-639-3151
Practice Address - Fax:423-639-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty