1144270711 NPI number — LANIER HEALTH SERVICES, INC.

Table of content: (NPI 1144270711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144270711 NPI number — LANIER HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANIER HEALTH SERVICES, 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:
LOUIS SMITH MEMORIAL HOSPITAL
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:
1144270711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5888
Provider Second Line Business Mailing Address:
ATTN: PFS DEPT.
Provider Business Mailing Address City Name:
VALDOSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31603-5888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-482-8401
Provider Business Mailing Address Fax Number:
229-482-8539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 W THIGPEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31635-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-482-8401
Provider Business Practice Location Address Fax Number:
229-482-8539
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAULS
Authorized Official First Name:
JACK
Authorized Official Middle Name:
RANDALL
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
229-333-1020

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  086-102 , 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: 000001163B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HOSP110 . This is a "CAHABA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000001163A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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