Provider Demographics
NPI:1083711691
Name:TY COBB HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:TY COBB HEALTHCARE SYSTEM
Other - Org Name:COBB MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-245-1290
Mailing Address - Street 1:521 FRANKLIN SPRINGS ST
Mailing Address - Street 2:PO BOX 589
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-3934
Mailing Address - Country:US
Mailing Address - Phone:706-245-5071
Mailing Address - Fax:706-245-1411
Practice Address - Street 1:521 FRANKLIN SPRINGS ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-3934
Practice Address - Country:US
Practice Address - Phone:706-245-5071
Practice Address - Fax:706-245-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059-521282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1100027Medicaid
GA000115OtherBCBS
MS07708770Medicaid
SC413823Medicaid
GAHOSP68OtherCAHABA MEDICARE PART B
GA110027B000000OtherTRAILBLAZER
GA00000437AMedicaid
2505724OtherAETNA
GA110027B000000OtherTRAILBLAZER