1790872018 NPI number — NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL

Table of content: (NPI 1790872018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790872018 NPI number — NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL
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:
MACON PRIMARY CARE CLINIC
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:
1790872018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 480
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39341-0480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-726-4264
Provider Business Mailing Address Fax Number:
662-726-4204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 N JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39341-0480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-726-4264
Provider Business Practice Location Address Fax Number:
662-726-4204
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKAY
Authorized Official First Name:
DANNY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
662-726-4231

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09014786 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com