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1760460448

NPI Code Detail

MEDICARE: PHOEBE WORTH MEDICAL CENTER, INC

MEDICARE: PHOEBE WORTH 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	275N00000X	Medicare Defined Swing Bed Hospital Unit

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000490	OTHER	GA	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760460448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOEBE WORTH MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	807 S ISABELLA ST
Second Line	:	P.O. BOX 545
City	:	SYLVESTER
State	:	GA
Zip	:	31791-7554
Country	:	US
Telephone Number	:	229-777-4514
Fax Number	:	229-776-7062

Provider Business Practice Location Address
First Line	:	807 S ISABELLA ST
Second Line	:
City	:	SYLVESTER
State	:	GA
Zip	:	31791-7554
Country	:	US
Telephone Number	:	229-777-4514
Fax Number	:	229-776-7062

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	STACEY L. FLYNT
Credential	:
Telephone Number	:	229-777-4514

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	11/15/2007

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Directions to “PHOEBE WORTH MEDICAL CENTER, INC ” Practice Location

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