1912903501 NPI number — HOST MANAGEMENT COMPANY, 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 1912903501 NPI number — HOST MANAGEMENT COMPANY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOST MANAGEMENT COMPANY, 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:
WOLF MEDICAL
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:
1912903501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1093 MEADOW BROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30188-6563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-778-2431
Provider Business Mailing Address Fax Number:
706-233-8277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1093 MEADOW BROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30188-6563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-778-2431
Provider Business Practice Location Address Fax Number:
706-233-8277
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COLVER
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
SINCLAIR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-778-2431

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  301083553 , 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: 000900699A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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