1053388256 NPI number — HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY

Table of content: (NPI 1053388256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053388256 NPI number — HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY
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:
6
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:
1053388256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 E SHOTWELL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAINBRIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
39819-4256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-246-3500
Provider Business Mailing Address Fax Number:
229-246-8142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 E SHOTWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAINBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39819-4256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-246-3500
Provider Business Practice Location Address Fax Number:
229-246-8142
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FAIRCLOTH
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
229-246-8211

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 43-112 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 1-043-500 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00001262T , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00001262S , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00141919A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00001262A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000307 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 096215500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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