Provider Demographics
NPI:1275314767
Name:JASPER HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:JASPER HEALTH SERVICES INC.
Other - Org Name:PRIMARY CARE CENTER NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
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:31064-1258
Mailing Address - Country:US
Mailing Address - Phone:706-468-4595
Mailing Address - Fax:
Practice Address - Street 1:4100 JACKSON LAKE RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064
Practice Address - Country:US
Practice Address - Phone:706-468-4588
Practice Address - Fax:706-468-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital