Provider Demographics
NPI:1144205014
Name:PHOEBE WORTH MEDICAL CENTER, INC
Entity type:Organization
Organization Name:PHOEBE WORTH MEDICAL CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-777-4514
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:807 S ISABELLA STREET
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-0545
Mailing Address - Country:US
Mailing Address - Phone:229-567-3361
Mailing Address - Fax:
Practice Address - Street 1:354 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:GA
Practice Address - Zip Code:31714-5222
Practice Address - Country:US
Practice Address - Phone:229-567-3361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00002109CMedicaid
GA113469Medicare ID - Type Unspecified