MEDICARE: THE MEDICAL CENTER, INC.

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1104130749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	500 18TH ST
Second Line	:	SUITE B-30
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1536
Country	:	US
Telephone Number	:	706-321-3765
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 18TH ST
Second Line	:	SUITE B-30
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1536
Country	:	US
Telephone Number	:	706-321-3765
Fax Number	:

Authorized Official
Title or Position	:	SR. VICE PRESIDENT/CFO
Name	:	MR. ROLAND THACKER
Credential	:
Telephone Number	:	706-571-1200

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	08/05/2010

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Directions to “THE MEDICAL CENTER, INC. ” Practice Location

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