Provider Demographics
NPI:1164779104
Name:MEADOWS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:MEADOWS REGIONAL MEDICAL CENTER
Other - Org Name:MEADOWS DIAGNOSTIC CENTER OF SAVANNAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO - VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-537-5826
Mailing Address - Street 1:1 MEADOWS PKWY
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8759
Mailing Address - Country:US
Mailing Address - Phone:912-538-5826
Mailing Address - Fax:
Practice Address - Street 1:11700 MERCY BLVD PLAZA D SUITE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1798
Practice Address - Country:US
Practice Address - Phone:912-961-8642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEADOWS REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-09
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA977-1261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology