Provider Demographics
NPI:1417173956
Name:DODGE COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:DODGE COUNTY HOSPITAL AUTHORITY
Other - Org Name:DODGE COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERSCHENK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-448-4066
Mailing Address - Street 1:901 GRIFFIN AVE
Mailing Address - Street 2:PO BOX 4309
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6720
Mailing Address - Country:US
Mailing Address - Phone:478-448-4000
Mailing Address - Fax:478-374-3491
Practice Address - Street 1:901 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6720
Practice Address - Country:US
Practice Address - Phone:478-448-4000
Practice Address - Fax:478-374-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAHOSP 167Medicare ID - Type UnspecifiedMEDICARE PART B GROUP