1124294434 NPI number — TRI-COUNTY HEALTH SYSTEM, INC.

Table of content: (NPI 1124294434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124294434 NPI number — TRI-COUNTY HEALTH SYSTEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-COUNTY HEALTH SYSTEM, INC.
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:
1124294434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 312
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30828-0312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-465-3253
Provider Business Mailing Address Fax Number:
706-465-3028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
156 ALEXANDER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRAWFORDVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30631-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-456-2925
Provider Business Practice Location Address Fax Number:
706-456-2224
Provider Enumeration Date:
05/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NEWSOME
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
706-465-3253

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000215982E . This is a "MEDICAID FFS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 08BBSCL . This is a "MEDICARE FFS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 08BDFLS . This is a "MEDICARE FFS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000302068K . This is a "MEDICAID FFS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000471809C . This is a "MEDICAID FQHC" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 08BDMNG . This is a "MEDICARE FFS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000308228C . This is a "MEDICAID FFS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000060387T . This is a "MEDICAID FFS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 08BDFZD . This is a "MEDICARE FFS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 980939645G . This is a "MEDICAID FFS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: GRP1619 . This is a "MEDICARE FFS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 08BBWTQ . This is a "MEDICARE FFS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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