1285637728 NPI number — SMITH RURAL HEALTH CLINIC

Table of content: (NPI 1285637728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285637728 NPI number — SMITH RURAL HEALTH CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITH RURAL HEALTH CLINIC
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:
1285637728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWAINSBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30401-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-237-7517
Provider Business Mailing Address Fax Number:
478-237-4299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 S JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWAINSBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30401-3146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-237-7517
Provider Business Practice Location Address Fax Number:
478-237-4299
Provider Enumeration Date:
05/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMSON
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
478-237-7517

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  113829 , 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: 00469664G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225102908 . This is a "HOWARD MD NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10047395 . This is a "AMERIGROUP GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1225102908 . This is a "BCBSGA/A HOWARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26760 . This is a "SRHC UNITED HLTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 924053 . This is a "A HOWARD UNITED HLTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 034616 . This is a "GA LISCENSE/AHOWARD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1023012580 . This is a "H WILDER SMITH JR PAC NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10054020 . This is a "AGROUP/A HOWARD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 336040 . This is a "WELLCARE GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000241689A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1588662506 . This is a "MASON W SMITH PAC NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11BDVCZ . This is a "MCAREPARTB/AHOWARD" identifier . This identifiers is of the category "OTHER".




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