1760436323 NPI number — DOCTORS HOSPITAL COLUMBUS GA - JOINT VENTURE

Table of content: (NPI 1760436323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760436323 NPI number — DOCTORS HOSPITAL COLUMBUS GA - JOINT VENTURE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS HOSPITAL COLUMBUS GA - JOINT VENTURE
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:
DOCTORS HOSPITAL (COLUMBUS)
Provider Other Organization Name Type Code:
3
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:
1760436323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31902-2188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-494-4262
Provider Business Mailing Address Fax Number:
706-494-4156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
616 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31901-1528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-494-4262
Provider Business Practice Location Address Fax Number:
706-494-4156
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SALLER
Authorized Official First Name:
BILL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
706-494-4381

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11269B , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01301290 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50007837 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0110186 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1200500 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135 . This is a "BLUE CROSS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2414293 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82323800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7336 . This is a "BLUECARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: COM0186N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP43761 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00148233A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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