1093039554 NPI number — EFFINGHAM COUNTY BOARD OF HEALTH

Table of content: (NPI 1093039554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093039554 NPI number — EFFINGHAM COUNTY BOARD OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EFFINGHAM COUNTY BOARD OF HEALTH
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:
1093039554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 SCRANTON CONNECTOR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31525-0540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-262-2347
Provider Business Mailing Address Fax Number:
912-262-3036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 HIGHWAY 119 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31329-0350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-754-6784
Provider Business Practice Location Address Fax Number:
912-754-7623
Provider Enumeration Date:
03/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
STACY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DISTRICT BILLING DEPT COORDINATOR
Authorized Official Telephone Number:
912-262-2347

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000051862B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FLU233 . This is a "MEDICARE ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000456497D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000456497N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000654376C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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