1174950729 NPI number — TATTNALL HOSPITAL COMPANY, LLC

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 1174950729 NPI number — TATTNALL HOSPITAL COMPANY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TATTNALL HOSPITAL COMPANY, LLC
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:
OPTIM MEDICAL CENTER- TATTNALL
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:
1174950729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 E DERENNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31405-6736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-644-5300
Provider Business Mailing Address Fax Number:
912-644-5260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 NORTH WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARIEN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31305-9141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-644-5300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GUENTHNER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY OF COMM.HOSP.HOLD.CO., LL
Authorized Official Telephone Number:
312-627-8427

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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