1851362263 NPI number — BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC

Table of content: (NPI 1851362263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851362263 NPI number — BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC
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:
1851362263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 198161
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-8161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2855 OLD HIGHWAY 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE RIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30513-6248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-632-3711
Provider Business Practice Location Address Fax Number:
706-632-7216
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EATON
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
QUALITY HIM DIRECTOR
Authorized Official Telephone Number:
706-632-4270

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 055-452 , 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: 1100189 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0053487 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0110189 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000157 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 053487 . This is a "BC TN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 182266100 . This is a "W/C" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010257500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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