Provider Demographics
NPI:1467663336
Name:HEALTHSPAN LLP
Entity Type:Organization
Organization Name:HEALTHSPAN LLP
Other - Org Name:BURKE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-554-4435
Mailing Address - Street 1:351 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-9686
Mailing Address - Country:US
Mailing Address - Phone:706-554-4435
Mailing Address - Fax:706-554-4435
Practice Address - Street 1:351 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-9686
Practice Address - Country:US
Practice Address - Phone:706-554-4435
Practice Address - Fax:706-554-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11U113Medicare Oscar/Certification