MEDICARE: MIDDLE FLINT AREA COMMUNITY SERVICE BOARD

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	251S00000X	Community/Behavioral Health Agency	582105225	GA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215934773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLE FLINT AREA COMMUNITY SERVICE BOARD

Provider Business Mailing Address
First Line	:	940 GA HIGHWAY 96 STE A
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2587
Country	:	US
Telephone Number	:	478-988-1002
Fax Number	:	478-988-8780

Provider Business Practice Location Address
First Line	:	940 GA HIGHWAY 96 STE A
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2587
Country	:	US
Telephone Number	:	478-988-1002
Fax Number	:	478-988-8780

Authorized Official
Title or Position	:	RCM MANAGER
Name	:	MARGARET JORDAN
Credential	:
Telephone Number	:	229-815-5454

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	12/15/2023

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Directions to “MIDDLE FLINT AREA COMMUNITY SERVICE BOARD ” Practice Location

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