Provider Demographics
NPI:1073600136
Name:ATLANTA HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:ATLANTA HOSPITAL AUTHORITY
Other - Org Name:ATLANTA MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-799-3000
Mailing Address - Street 1:PO BOX 1049
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-1049
Mailing Address - Country:US
Mailing Address - Phone:903-799-3000
Mailing Address - Fax:903-799-3005
Practice Address - Street 1:1007 S WILLIAM ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-3245
Practice Address - Country:US
Practice Address - Phone:903-799-3000
Practice Address - Fax:903-799-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000131282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH0664OtherBLUE CROSS BLUE SHIELD
AR107585105Medicaid
TX122058OtherSUPERIOR HEALTH PLAN
AR80274OtherBLUE CROSS BLUE SHIELD
TX133255305Medicaid
LA1736589Medicaid
LA1736589Medicaid