1881776946 NPI number — SOUTHWESTERN STATE HOSPITAL

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 1881776946 NPI number — SOUTHWESTERN STATE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWESTERN STATE 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:
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:
1881776946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1378
Provider Second Line Business Mailing Address:
PATIENT BILLING DEPT
Provider Business Mailing Address City Name:
THOMASVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31799-1378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-227-2977
Provider Business Mailing Address Fax Number:
229-227-2955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 COVE LANDING DR
Provider Second Line Business Practice Location Address:
COMMUNITY MEDICAID WAIVER HOME MRWP
Provider Business Practice Location Address City Name:
THOMASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31792-3883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-227-2977
Provider Business Practice Location Address Fax Number:
229-227-2955
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOO-YOU
Authorized Official First Name:
HILARY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
REGIONAL HOSPITAL ADMINISTRATOR
Authorized Official Telephone Number:
229-227-3021

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  136-01-076-1 , 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: 00877236I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com