Provider Demographics
NPI:1457448946
Name:GENEVA COUNTY HEALTHCARE AUTHORITY, INC.
Entity Type:Organization
Organization Name:GENEVA COUNTY HEALTHCARE AUTHORITY, INC.
Other - Org Name:SAMSON MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-684-3655
Mailing Address - Street 1:98 E MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:SAMSON
Mailing Address - State:AL
Mailing Address - Zip Code:36477-1229
Mailing Address - Country:US
Mailing Address - Phone:334-898-2728
Mailing Address - Fax:334-898-2774
Practice Address - Street 1:98 E MORRIS ST
Practice Address - Street 2:
Practice Address - City:SAMSON
Practice Address - State:AL
Practice Address - Zip Code:36477
Practice Address - Country:US
Practice Address - Phone:334-898-2728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENEVA COUNTY HEALTH CARE AUTHORITY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL065559207Q00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01-0062Medicare ID - Type UnspecifiedWIREGRASS MEDICAL CTR #