1700851649 NPI number — CRISP REGIONAL HOSPITAL INC

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 1700851649 NPI number — CRISP REGIONAL HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRISP REGIONAL HOSPITAL 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:
Provider Other Organization Name Type Code:
6
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:
1700851649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORDELE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31015-5007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-271-9686
Provider Business Mailing Address Fax Number:
229-271-9689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 7TH ST NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORDELE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-271-9686
Provider Business Practice Location Address Fax Number:
229-271-9689
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEARDEN
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
DIR REV INT
Authorized Official Telephone Number:
229-276-3146

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NR1301X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NR1301X , with the licence number: 040495 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 040495 , 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: 000000514A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 907757000 . 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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