Provider Demographics
NPI:1053301127
Name:AUGUSTA HEALTH CARE, INC
Entity Type:Organization
Organization Name:AUGUSTA HEALTH CARE, INC
Other - Org Name:T/A AUGUSTA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACHE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:MANNIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-932-4000
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-1000
Mailing Address - Country:US
Mailing Address - Phone:540-932-5162
Mailing Address - Fax:540-932-4616
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-932-4000
Practice Address - Fax:540-932-4616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH 1826282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA509847OtherSOUTHERN HEALTH
VA000014OtherANTHEM
VA4900189Medicaid
VA=========OtherCIGNA
VA=========001OtherCHAMPUS/TRICARE
VA=========001OtherCHAMPUS/TRICARE
VA490018Medicare Oscar/Certification