Provider Demographics
NPI:1407023039
Name:THE MEDICAL CENTER HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:THE MEDICAL CENTER HOSPITAL AUTHORITY
Other - Org Name:HUGHSTON HOSPITAL REHABILITATION UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCMICKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-660-6103
Mailing Address - Street 1:707 CENTER ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1575
Mailing Address - Country:US
Mailing Address - Phone:706-660-6103
Mailing Address - Fax:706-660-6520
Practice Address - Street 1:100 FRIST CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3578
Practice Address - Country:US
Practice Address - Phone:706-494-2100
Practice Address - Fax:706-494-2446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEDICAL CENTER HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-13
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11T200Medicare Oscar/Certification