1871894246 NPI number — MAC-LUMPKIN RD LLC

Table of content: (NPI 1871894246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871894246 NPI number — MAC-LUMPKIN RD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAC-LUMPKIN RD 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:
ACUTE CARE OF SOUTH COLUMBUS
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:
1871894246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31902-1038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-571-1976
Provider Business Mailing Address Fax Number:
706-660-6512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1627 S LUMPKIN RD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31903-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-243-4154
Provider Business Practice Location Address Fax Number:
706-243-4154
Provider Enumeration Date:
11/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BROUWER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
706-660-6155

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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