Provider Demographics
NPI:1346294303
Name:NORTHLAKE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:NORTHLAKE MEDICAL CENTER LLC
Other - Org Name:NORTHLAKE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SATTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-270-3010
Mailing Address - Street 1:1455 MONTREAL RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8100
Mailing Address - Country:US
Mailing Address - Phone:770-270-3000
Mailing Address - Fax:770-270-3199
Practice Address - Street 1:1455 MONTREAL RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8100
Practice Address - Country:US
Practice Address - Phone:770-270-3000
Practice Address - Fax:770-270-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037132200Medicaid
NE10025106700Medicaid
SC10809AMedicaid
158331700OtherDEPT OF LABOR
MI304783690Medicaid
ALEMO0033NMedicaid
IN200179210AMedicaid
OH2543117Medicaid
GA00000547AMedicaid
LA1757811Medicaid
TN3119396OtherBLUECARE
KY50004977OtherPASSPORT
WI81479600Medicaid
VA010110491Medicaid
GA3566OtherBLUE CROSS
MD410333500Medicaid
RIOP10033Medicaid
NY2064377Medicaid
WA3026168Medicaid
AZ883448Medicaid
FL912980400Medicaid
FL912980400Medicaid
DC037132200Medicaid