Provider Demographics
NPI:1508810565
Name:REDMOND PARK HOSPITAL, LLC
Entity Type:Organization
Organization Name:REDMOND PARK HOSPITAL, LLC
Other - Org Name:REDMOND REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUSIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-802-3035
Mailing Address - Street 1:501 REDMOND RD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1415
Mailing Address - Country:US
Mailing Address - Phone:706-291-0291
Mailing Address - Fax:706-291-0971
Practice Address - Street 1:501 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1415
Practice Address - Country:US
Practice Address - Phone:706-291-0291
Practice Address - Fax:706-291-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7153OtherBLUECARE
ALHOS0168PMedicaid
156120400OtherDEPT OF LABOR
GA100069OtherBLUE CROSS
GA00001581AMedicaid
OK200044050AMedicaid
TN0110168Medicaid
FL902540500Medicaid
GA100069OtherBLUE CROSS