Provider Demographics
NPI:1083842694
Name:SAINT JOSEPH'S HOSPITAL, INC.
Entity Type:Organization
Organization Name:SAINT JOSEPH'S HOSPITAL, INC.
Other - Org Name:ST. JOSEPH'S HOSPITAL PATHOLOGY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:HINCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-819-2404
Mailing Address - Street 1:5353 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6015
Mailing Address - Country:US
Mailing Address - Phone:912-819-5290
Mailing Address - Fax:912-819-5295
Practice Address - Street 1:11705 MERCY BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1711
Practice Address - Country:US
Practice Address - Phone:912-819-2404
Practice Address - Fax:912-819-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025009291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00001801AMedicaid
GA11D0022060OtherCLIA ID NUMBER
GA00001801AMedicaid