Provider Demographics
NPI:1548214257
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:706-802-3029
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:706-368-8386
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:706-368-8386
Practice Address - Fax:706-291-0971
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDMOND PARK HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
11T168Medicare Oscar/Certification