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General NPI Number Information
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NPI Number | 1104914480
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Entity Type | Organization
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Legal Business Name | BACCHUS OPERATIONS GROUP, INC.
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 502 SUMTER ST
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City | MONTEZUMA
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State | GA
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Zip | 31063-1734
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Country | US
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Telephone | 478-472-8178
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Fax | 478-472-3289
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Provider Business Mailing Address
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Address Line | 509 SUMTER ST P.O. BOX 770 (31063-2502)
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City | MONTEZUMA
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State | GA
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Zip | 31063-1733
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Country | US
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Telephone | 478-472-3100
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Fax | 478-472-3248
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. MICHAEL C PATTERSON
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Credential |
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Telephone | 478-472-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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