1720095805 NPI number — DONALSONVILLE HOSPITAL INC

Table of content: (NPI 1720095805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720095805 NPI number — DONALSONVILLE HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONALSONVILLE 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:
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:
1720095805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 HOSPITAL CIRCLE
Provider Second Line Business Mailing Address:
DONALSONVILLE HOSPITAL
Provider Business Mailing Address City Name:
DONALSONVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
39845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-524-5217
Provider Business Mailing Address Fax Number:
229-524-8217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 HOSPITAL CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DONALSONVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-524-5217
Provider Business Practice Location Address Fax Number:
229-524-8217
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ORRICK
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
H
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
229-524-5217

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  125318 , 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: 00206181A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1D000206181A . This is a "MEDICAID PHYSICIANS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 11U194 . This is a "MEDICARE/SWINGBED" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: CB5811 . This is a "PALMETTO MEDICARE PART B" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: HOSP52 . This is a "CAHABA/MEDICARE PART B" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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