1134350358 NPI number — BAPTIST EASLEY HOSPITAL

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 1134350358 NPI number — BAPTIST EASLEY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST EASLEY HOSPITAL
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:
BAPTIST EASLEY HOSPITAL BASED PROVIDERS
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:
1134350358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 743219
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-3219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-855-5104
Provider Business Mailing Address Fax Number:
864-859-9362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 FLEETWOOD DR FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASLEY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29640-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-855-5104
Provider Business Practice Location Address Fax Number:
864-859-9362
Provider Enumeration Date:
08/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
STAPLETON
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
864-442-8610

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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