Provider Demographics
NPI:1124038294
Name:HOSPITAL AUTHORITY OF BEN HILL
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF BEN HILL
Other - Org Name:DORMINY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:PAULK
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:229-424-7100
Mailing Address - Street 1:200 PERRY HOUSE RD
Mailing Address - Street 2:PO BOX 1447
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8857
Mailing Address - Country:US
Mailing Address - Phone:229-424-7100
Mailing Address - Fax:229-424-7281
Practice Address - Street 1:200 PERRY HOUSE RD
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8857
Practice Address - Country:US
Practice Address - Phone:229-424-7100
Practice Address - Fax:229-424-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009-288282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000613DMedicaid
GA00082OtherBLUE CROSS PROVIDER #
GA113466Medicare ID - Type UnspecifiedPROVIDER NUMBER