1629041421 NPI number — HOSPITAL AUTHORITY OF RANDOLPH COUNTY

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 1629041421 NPI number — HOSPITAL AUTHORITY OF RANDOLPH COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL AUTHORITY OF RANDOLPH 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:
1629041421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 WEST RAILROAD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELLMAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
39886-5003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-679-5579
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 WEST RAILROAD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELLMAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39886-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-679-5579
Provider Business Practice Location Address Fax Number:
229-679-5584
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILMAN
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
229-209-1242

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , 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: 614225598A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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