=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053388256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2006
-----------------------------------------------------
Last Update Date | 01/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 E SHOTWELL ST
-----------------------------------------------------
City | BAINBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 39819-4256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-246-3500
-----------------------------------------------------
Fax | 229-246-8142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 E SHOTWELL ST
-----------------------------------------------------
City | BAINBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 39819-4256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-246-3500
-----------------------------------------------------
Fax | 229-246-8142
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | KAREN FAIRCLOTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 229-246-8211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 43-112
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 1-043-500
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------