Provider Demographics
NPI:1174506737
Name:LONG COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:LONG COUNTY BOARD OF HEALTH
Other - Org Name:LONG COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT BILLING DEPT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-262-2347
Mailing Address - Street 1:150 SCRANTON CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0540
Mailing Address - Country:US
Mailing Address - Phone:912-262-2347
Mailing Address - Fax:912-262-3036
Practice Address - Street 1:584 N MACON ST
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316-5958
Practice Address - Country:US
Practice Address - Phone:912-545-2107
Practice Address - Fax:912-545-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2015-01-07
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-07-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000051818HMedicaid
GAFLU147OtherMEDICARE ID
GA000551878AMedicaid
GA000051818FMedicaid
GA000457938EMedicaid
GA000051818HMedicaid