1477830164 NPI number — MGAS HOLDINGS, LLC

Table of content: MRS. ROBIN MARIE ADAMS HS (NPI 1851489777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477830164 NPI number — MGAS HOLDINGS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MGAS HOLDINGS, 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:
Provider Other Organization Name Type Code:
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:
1477830164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2710
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31203-2710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-741-4141
Provider Business Mailing Address Fax Number:
478-742-0358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
242 HOLT AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31201-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-741-4141
Provider Business Practice Location Address Fax Number:
877-455-7182
Provider Enumeration Date:
11/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SOMERS
Authorized Official First Name:
BELINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR
Authorized Official Telephone Number:
478-508-0685

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  011-04 , 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: 003125241A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01089084 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012915000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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