1780638833 NPI number — CARTERSVILLE MEDICAL CENTER LLC

Table of content: (NPI 1780638833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780638833 NPI number — CARTERSVILLE MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARTERSVILLE MEDICAL CENTER 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:
CARTERSVILLE MEDICAL CENTER
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:
1780638833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
960 JOE FRANK HARRIS PKWY SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARTERSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30120-2129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-382-1530
Provider Business Mailing Address Fax Number:
770-606-2127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 JOE FRANK HARRIS PKWY SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30120-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-382-1530
Provider Business Practice Location Address Fax Number:
770-606-2127
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CROSS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VP GOVERNMENT REIMBURSEMENT
Authorized Official Telephone Number:
470-271-3401

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 089328 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11066A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158337300 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 911642700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: EMO0030N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82554300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000001625A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018091580003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0110030 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01300318 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146981901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100504458 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1012487 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2339222 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29686521 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3075476 . This is a "BLUECARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 01698 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1704857 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 269740 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3570 . This is a "BLUE CROSS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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