Provider Demographics
NPI:1427392307
Name:JENKINS COUNTY HOSPITAL, LLC
Entity Type:Organization
Organization Name:JENKINS COUNTY HOSPITAL, LLC
Other - Org Name:OPTIM PRIMARY CARE - SARDIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLEINPETER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:912-644-5300
Mailing Address - Street 1:210 E. DERENNE AVE
Mailing Address - Street 2:ATTN: HOPE SAMS
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:639 VESTAL RD
Practice Address - Street 2:
Practice Address - City:SARDIS
Practice Address - State:GA
Practice Address - Zip Code:30456
Practice Address - Country:US
Practice Address - Phone:478-569-4406
Practice Address - Fax:912-644-5260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENKINS COUNTY HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-16
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty