1124296249 NPI number — MIDDLE FLINT COMMUNITY BOARD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124296249 NPI number — MIDDLE FLINT COMMUNITY BOARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDDLE FLINT COMMUNITY BOARD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MIDDLE FLINT BEHAVIORAL HEALTHCARE AMHDT
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124296249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 N JACKSON ST
Provider Second Line Business Mailing Address:
P.O. DRAWER 1348
Provider Business Mailing Address City Name:
AMERICUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31709-3015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-931-2470
Provider Business Mailing Address Fax Number:
229-931-2474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HEADS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMERICUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31709-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-931-2470
Provider Business Practice Location Address Fax Number:
229-931-2474
Provider Enumeration Date:
02/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JORDAN
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
Authorized Official Title or Position:
UTILIZATION MANAGER
Authorized Official Telephone Number:
229-815-5286

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000603237F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com