1235227752 NPI number — THE HOSPITAL AUTHORITY OF MILLER COUNTY

Table of content: (NPI 1235227752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235227752 NPI number — THE HOSPITAL AUTHORITY OF MILLER COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HOSPITAL AUTHORITY OF MILLER 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:
1235227752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 N CUTHBERT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLQUITT
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
39837-3518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-758-4200
Provider Business Mailing Address Fax Number:
229-758-5198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 RE JENNINGS AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39813-8725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-725-4251
Provider Business Practice Location Address Fax Number:
229-725-2212
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAU
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
229-758-5954

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003140349A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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