Provider Demographics
NPI:1497169429
Name:POLK MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:POLK MEDICAL CENTER, INC
Other - Org Name:POLK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:STUENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-509-6900
Mailing Address - Street 1:420 E 2ND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3209
Mailing Address - Country:US
Mailing Address - Phone:706-509-3000
Mailing Address - Fax:
Practice Address - Street 1:2360 ROCKMART HWY
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-6029
Practice Address - Country:US
Practice Address - Phone:770-748-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POLK MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-18
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11Z330Medicare Oscar/Certification