1780293035 NPI number — THE HOSPITAL AUTHORITY OF MILLER COUNTY

Table of content: (NPI 1780293035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780293035 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:
1780293035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 N CUTHBERT STREET, P.O. BOX 7
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:
229-758-4212
Provider Business Mailing Address Fax Number:
229-758-2668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 DELORES ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLQUITT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39837-3528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-758-2029
Provider Business Practice Location Address Fax Number:
229-758-2092
Provider Enumeration Date:
07/23/2020

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:
229-758-3885

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHHH000074 . This is a "LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 003242112A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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