1376750976 NPI number — CRISP REGIONAL HOSPITAL, INC

Table of content: (NPI 1376750976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376750976 NPI number — CRISP REGIONAL HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRISP REGIONAL HOSPITAL, INC
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:
CRISP REGIONAL CONVENIENT CARE
Provider Other Organization Name Type Code:
3
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:
1376750976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORDELE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31015-3275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-276-2000
Provider Business Mailing Address Fax Number:
229-276-2184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORDELE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31015-3275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-271-9330
Provider Business Practice Location Address Fax Number:
229-271-9245
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
DIRECTOR PHYSICIAN PRACTICES
Authorized Official Telephone Number:
229-271-4676

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11-8907 . This is a "MCR CCN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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