Provider Demographics
NPI:1497064679
Name:JENKINS COUNTY HOSPITAL LLC
Entity Type:Organization
Organization Name:JENKINS COUNTY HOSPITAL LLC
Other - Org Name:OPTIM MEDICAL CENTER - JENKINS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY OF JENKINS COUNTY HOSPITA
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUENTHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-627-8247
Mailing Address - Street 1:210 E DERENNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6736
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:931 E WINTHROPE AVE
Practice Address - Street 2:
Practice Address - City:MILLEN
Practice Address - State:GA
Practice Address - Zip Code:30442-1839
Practice Address - Country:US
Practice Address - Phone:478-982-4221
Practice Address - Fax:478-982-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA082-270282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111311Medicare Oscar/Certification
GAHOSP106Medicare Oscar/Certification