Provider Demographics
NPI:1225031750
Name:JASPER HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:JASPER HEALTH SERVICES, INC.
Other - Org Name:JASPER MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMBIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-468-4595
Mailing Address - Street 1:898 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:GA
Mailing Address - Zip Code:31064-1261
Mailing Address - Country:US
Mailing Address - Phone:706-468-6411
Mailing Address - Fax:706-468-9880
Practice Address - Street 1:898 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-1261
Practice Address - Country:US
Practice Address - Phone:706-468-6411
Practice Address - Fax:706-468-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-30
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043094207Q00000X
GA058023207R00000X
GA079-592282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACH9580OtherRAILROAD MEDICARE
GA00000998AMedicaid
GA00000998AMedicaid
GA11-1303Medicare ID - Type UnspecifiedMEDICARE IP