Provider Demographics
NPI:1457478950
Name:BACON COUNTY HOSPITAL AND HEALTH SYSTEM
Entity Type:Organization
Organization Name:BACON COUNTY HOSPITAL AND HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:912-632-8961
Mailing Address - Street 1:302 S WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-2922
Mailing Address - Country:US
Mailing Address - Phone:912-632-8961
Mailing Address - Fax:912-632-2231
Practice Address - Street 1:302 S WAYNE ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-2922
Practice Address - Country:US
Practice Address - Phone:912-632-8961
Practice Address - Fax:912-632-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111327Medicare ID - Type Unspecified