MEDICARE: TY COBB HEALTHCARE SYSTEM

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	282NR1301X	Rural Acute Care Hospital	059-521	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	HOSP68	OTHER	GA	CAHABA MEDICARE PART B

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	000115	OTHER	GA	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	110027B000000	OTHER	GA	TRAILBLAZER
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	2505724	OTHER		AETNA

General Provider Information

NPI Number	:	1083711691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TY COBB HEALTHCARE SYSTEM

Provider Business Mailing Address
First Line	:	521 FRANKLIN SPRINGS ST
Second Line	:	PO BOX 589
City	:	ROYSTON
State	:	GA
Zip	:	30662-3934
Country	:	US
Telephone Number	:	706-245-5071
Fax Number	:	706-245-1411

Provider Business Practice Location Address
First Line	:	521 FRANKLIN SPRINGS ST
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-3934
Country	:	US
Telephone Number	:	706-245-5071
Fax Number	:	706-245-1411

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MISS KIMBERLY A MASSEY
Credential	:
Telephone Number	:	706-245-1290

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	05/23/2008

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Directions to “TY COBB HEALTHCARE SYSTEM ” Practice Location

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