Provider Demographics
NPI:1164574885
Name:MACON COUNTY MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:MACON COUNTY MEDICAL CENTER, INC
Other - Org Name:FLINT RIVER CLINIC AT BUTLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIR
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:478-472-3244
Mailing Address - Street 1:80 WEST MAIN ST.
Mailing Address - Street 2:STE B
Mailing Address - City:BUTLER
Mailing Address - State:GA
Mailing Address - Zip Code:31006-5156
Mailing Address - Country:US
Mailing Address - Phone:478-862-3879
Mailing Address - Fax:
Practice Address - Street 1:80 WEST MAIN STREET
Practice Address - Street 2:STE B
Practice Address - City:BUTLER
Practice Address - State:GA
Practice Address - Zip Code:31006-5156
Practice Address - Country:US
Practice Address - Phone:478-862-3879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA087221830AMedicaid
GA118517Medicare Oscar/Certification