1356344915 NPI number — CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY

Table of content: (NPI 1356344915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356344915 NPI number — CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY
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:
LANIER HEALTH SERVICES
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:
1356344915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 48TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36854-3666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-756-9180
Provider Business Mailing Address Fax Number:
334-756-6678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 48TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36854-3666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-756-9180
Provider Business Practice Location Address Fax Number:
334-756-5874
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LEROY
Authorized Official First Name:
KURT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CIO
Authorized Official Telephone Number:
334-756-9180

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  10478 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00061773A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1912929068 . This is a "FAGAN NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: HOS0025H , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: PEC0025H , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 529929850 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010076 . This is a "BCBS HOSP PROVIDER #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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