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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
1261QR1300XRural Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891770764
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHOEBE WORTH MEDICAL CENTER, INC
Provider Business Mailing Address
First Line : PO BOX 545
Second Line : 807 S ISABELLA STREET
City : SYLVESTER
State : GA
Zip : 31791-0545
Country : US
Telephone Number : 229-776-2965
Fax Number : 229-776-4452
Provider Business Practice Location Address
First Line : 1014 W FRANKLIN ST
Second Line :
City : SYLVESTER
State : GA
Zip : 31791-1978
Country : US
Telephone Number : 229-776-2965
Fax Number : 229-776-4452
Authorized Official
Title or Position : BUSINESS OFFICE MANAGER
Name : STACEY L FLYNT
Credential :
Telephone Number : 229-777-4514
Provider Enumeration Date : 12/13/2005
Last Update Date : 11/13/2007

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

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