Provider Demographics
NPI:1003180357
Name:REGENCY HOSPITAL COMPANY OF MACON LLC
Entity Type:Organization
Organization Name:REGENCY HOSPITAL COMPANY OF MACON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-972-1100
Mailing Address - Street 1:535 COLISEUM DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-0104
Mailing Address - Country:US
Mailing Address - Phone:478-803-7300
Mailing Address - Fax:478-803-7531
Practice Address - Street 1:535 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-0104
Practice Address - Country:US
Practice Address - Phone:478-803-7300
Practice Address - Fax:478-803-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty