Provider Demographics
NPI:1184673030
Name:JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.
Other - Org Name:ARCHBOLD HEALTH SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AVP
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-228-2229
Mailing Address - Street 1:2705 E. PINETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4875
Mailing Address - Country:US
Mailing Address - Phone:229-551-2365
Mailing Address - Fax:229-225-9382
Practice Address - Street 1:2705 E. PINETREE BLVD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4875
Practice Address - Country:US
Practice Address - Phone:229-551-2365
Practice Address - Fax:229-225-9382
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00376879AMedicaid
GA00185061AMedicaid
GA00382599AMedicaid
GA00377495AMedicaid
GA00647358AMedicaid
GA00647358AMedicaid