1235149402 NPI number — HOUSTON COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1235149402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235149402 NPI number — HOUSTON COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSTON COUNTY HEALTH DEPARTMENT
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:
HOUSTON COUNTY BOARD OF HEALTH
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:
1235149402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 2ND ST STE 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31201-6328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-297-5190
Provider Business Mailing Address Fax Number:
478-751-6099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98 COHEN WALKER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARNER ROBINS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31088-0744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-218-2000
Provider Business Practice Location Address Fax Number:
478-218-2017
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRAFT
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
DISTRICT HEALTH DIRECTOR
Authorized Official Telephone Number:
478-751-6303

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003188424A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003205022A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600001601 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000733169A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00051961F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003161295B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00460336F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FLU171 . This is a "MEDICARE PTAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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