Provider Demographics
NPI:1073567038
Name:PALMYRA PARK HOSPITAL, INC.
Entity Type:Organization
Organization Name:PALMYRA PARK HOSPITAL, INC.
Other - Org Name:PALMYRA MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-434-2100
Mailing Address - Street 1:2000 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1528
Mailing Address - Country:US
Mailing Address - Phone:912-434-2000
Mailing Address - Fax:912-434-2563
Practice Address - Street 1:2000 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1528
Practice Address - Country:US
Practice Address - Phone:229-434-2000
Practice Address - Fax:229-434-2138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA279OtherBLUE CROSS
MO012394508Medicaid
LA1704156Medicaid
SC10055AMedicaid
GA00001416AMedicaid
NY01807661Medicaid
156077000OtherDEPT OF LABOR
FL91791500Medicare ID - Type UnspecifiedMEDICAID OF FL
NY01807661Medicaid