Provider Demographics
NPI:1477211779
Name:DODGE COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:DODGE COUNTY HOSPITAL AUTHORITY
Other - Org Name:DODGE IMMEDIATE HEALTH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-448-4050
Mailing Address - Street 1:829 PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6757
Mailing Address - Country:US
Mailing Address - Phone:478-374-7801
Mailing Address - Fax:478-374-7878
Practice Address - Street 1:829 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6757
Practice Address - Country:US
Practice Address - Phone:478-374-7801
Practice Address - Fax:478-374-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty