EASTSIDE MEDICAL CENTER, LLC

Provider Demographics

• NPI: 1467406132
• Name: EASTSIDE MEDICAL CENTER, LLC
• Entity Type: Organization
• Organization Name: EASTSIDE MEDICAL CENTER, LLC
• Other - Org Name: PIEDMONT EASTSIDE MEDICAL CENTER
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: VP GOVERNMENT REIMBURSEMENT
• Authorized Official - First Name: ROBERT
• Authorized Official - Middle Name: C
• Authorized Official - Last Name: CROSS
• Authorized Official - Phone: 470-271-3401
• Mailing Address - Street 1: 1700 MEDICAL WAY
• Mailing Address - City: SNELLVILLE
• Mailing Address - State: GA
• Mailing Address - Zip Code: 30078-2195
• Mailing Address - Country: US
• Mailing Address - Phone: 770-979-0200
• Mailing Address - Fax: 770-736-2395
• Practice Address - Street 1: 1700 MEDICAL WAY
• Practice Address - City: SNELLVILLE
• Practice Address - State: GA
• Practice Address - Zip Code: 30078-2195
• Practice Address - Country: US
• Practice Address - Phone: 770-979-0200
• Practice Address - Fax: 770-736-2395
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-19
• Last Update Date: 2024-02-26

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital

Provider Identifiers

State	Identifier ID	ID Type	Issuer
GA	00190088A	Medicaid
	158328200	Other	DEPT OF LABOR
PA	30000595	Medicaid
MD	406635900	Medicaid
TX	071850401	Medicaid
WI	82176800	Medicaid
AR	157505105	Medicaid
MI	308068059	Medicaid
SC	143405	Medicaid
IN	200225640A	Medicaid
NY	82092	Medicaid
AL	HOS0192N	Medicaid
NJ	0067598	Medicaid
TN	0110192	Medicaid
	1526531	Other	GATEWAY MEDICAID HMO
NY	1633343	Medicaid
	3564	Other	BLUE CROSS
	4001267	Other	BLUE CARE
ME	421810000	Medicaid
CA	XHSP33294	Medicaid
WA	3022050	Medicaid
KY	50002177	Medicaid
FL	909638800	Medicaid
DC	036540100	Medicaid
MA	1010484	Medicaid
AZ	119513	Medicaid
PA	30000595	Medicaid
DC	036540100	Medicaid