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1053388256

NPI Code Detail

MEDICARE: HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY

MEDICARE: HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY

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	275N00000X	Medicare Defined Swing Bed Hospital Unit
2	282N00000X	General Acute Care Hospital	43-112	GA
3	314000000X	Skilled Nursing Facility	1-043-500	GA
4	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000307	OTHER	GA	BLUE CROSS BLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053388256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY

Provider Business Mailing Address
First Line	:	1500 E SHOTWELL ST
Second Line	:
City	:	BAINBRIDGE
State	:	GA
Zip	:	39819-4256
Country	:	US
Telephone Number	:	229-246-3500
Fax Number	:	229-246-8142

Provider Business Practice Location Address
First Line	:	1500 E SHOTWELL ST
Second Line	:
City	:	BAINBRIDGE
State	:	GA
Zip	:	39819-4256
Country	:	US
Telephone Number	:	229-246-3500
Fax Number	:	229-246-8142

Authorized Official
Title or Position	:	CFO
Name	:	KAREN FAIRCLOTH
Credential	:
Telephone Number	:	229-246-8211

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	01/27/2022

Similar Medicare Providers

1407857303 — DR. MARCIA WILLIS BROCK PHARMD
Practice Location Address:

1500 E SHOTWELL ST
BAINBRIDGE, GA
39819-4256

Practice Phone: 229-243-6163
Practice Fax: 229-243-3327

1881683324 — HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY
Practice Location Address:

1500 E SHOTWELL ST
BAINBRIDGE, GA
39819-4256

Practice Phone: 229-243-6100
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1023076981 — DR. THOMAS H. PARKER JR. MD
Practice Location Address:

1500 E SHOTWELL ST , THOMAS H PARKER JR, MD, PC DBA BAINBRIDGE ANESTHESIA
BAINBRIDGE, GA
39819-4256

Practice Phone: 229-246-3500
Practice Fax:

1740202290 — JOHN B REYNOLDS MD
Practice Location Address:

1500 E SHOTWELL ST
BAINBRIDGE, GA
39819-4256

Practice Phone: 229-243-6100
Practice Fax:

1609889021 — MRS. ELIZABETH MARIA HOLLIS NP
Practice Location Address:

1500 E SHOTWELL ST
BAINBRIDGE, GA
39819-4256

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Practice Fax:

1487721718 — VICTORIA LEWIS-HOLLAND D.O.
Practice Location Address:

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39819-4256

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Practice Fax:

Directions to “HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY ” Practice Location

Language	Start Address	Practice Location

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