Provider Demographics
NPI:1093248486
Name:SOUTHEAST GEORGIA HEALTH SERVICES, L.L.C.
Entity Type:Organization
Organization Name:SOUTHEAST GEORGIA HEALTH SERVICES, L.L.C.
Other - Org Name:MEMORIAL SATILLA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-287-2500
Mailing Address - Street 1:1900 TEBEAU ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6357
Mailing Address - Country:US
Mailing Address - Phone:912-283-3030
Mailing Address - Fax:912-287-2505
Practice Address - Street 1:1900 TEBEAU ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6357
Practice Address - Country:US
Practice Address - Phone:912-283-3030
Practice Address - Fax:912-287-2505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST GEORGIA HEALTH SERVICES, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
11S0003Medicare Oscar/Certification