MEDICARE: PRIVATE HEALTHCARE FACILITIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QB0400X	Birthing Clinic/Center

General Provider Information

NPI Number	:	1477201739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIVATE HEALTHCARE FACILITIES

Provider Business Mailing Address
First Line	:	902 KITTY HAWK RD # 170487
Second Line	:
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78148-3825
Country	:	US
Telephone Number	:	866-996-2340
Fax Number	:	888-329-2091

Provider Business Practice Location Address
First Line	:	3338 COUNTRY CLUB RD
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31605-1044
Country	:	US
Telephone Number	:	866-996-2340
Fax Number	:	866-399-0991

Authorized Official
Title or Position	:	OFFICE STAFF
Name	:	PRISCILLA HOLLINGSWORTH
Credential	:
Telephone Number	:	866-996-2340

Provider Enumeration Date	:	03/16/2022
Last Update Date	:	12/22/2024

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