1376518118 NPI number — CRISP REGIONAL HOSPITAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376518118 NPI number — CRISP REGIONAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRISP REGIONAL HOSPITAL, 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:
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:
1376518118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
906 N 5TH ST
Provider Second Line Business Mailing Address:
SUITE F6
Provider Business Mailing Address City Name:
CORDELE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31015-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-271-4690
Provider Business Mailing Address Fax Number:
229-271-4694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
906 N 5TH ST
Provider Second Line Business Practice Location Address:
SUITE F6
Provider Business Practice Location Address City Name:
CORDELE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-271-4690
Provider Business Practice Location Address Fax Number:
229-271-4694
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEARDEN
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
DIR REV INT
Authorized Official Telephone Number:
229-276-3146

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  040175 , 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: 000696429A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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