Provider Demographics
NPI:1093115123
Name:TATTNALL HOSPITAL COMPANY, LLC
Entity Type:Organization
Organization Name:TATTNALL HOSPITAL COMPANY, LLC
Other - Org Name:OPTIM MEDICAL CENTER- TATTNALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY OF COMM.HOSP.HOLD.CO., LL
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUENTHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-627-8247
Mailing Address - Street 1:210 E DERENNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6736
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:3345 US HIGHWAY 84
Practice Address - Street 2:SUITE 100
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-2159
Practice Address - Country:US
Practice Address - Phone:912-807-7242
Practice Address - Fax:912-807-7243
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TATTNALL HOSPITAL COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-26
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty