=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548251366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2005
-----------------------------------------------------
Last Update Date | 11/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 48TH ST
-----------------------------------------------------
City | VALLEY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36854-3666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-756-1648
-----------------------------------------------------
Fax | 334-756-5874
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 348 4800 48TH ST
-----------------------------------------------------
City | VALLEY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36854-3666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-756-1648
-----------------------------------------------------
Fax | 334-756-5874
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | FRANK OPRANDY III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 334-756-1495
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number | 001809
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------