Provider Demographics
NPI:1548596737
Name:RINCON MEDICAL CENTER
Entity Type:Organization
Organization Name:RINCON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SLAVKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KUKUCKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-826-0229
Mailing Address - Street 1:119 CHIMNEY ROAD
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326
Mailing Address - Country:US
Mailing Address - Phone:912-826-0229
Mailing Address - Fax:912-826-0449
Practice Address - Street 1:119 CHIMNEY ROAD
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326
Practice Address - Country:US
Practice Address - Phone:912-826-0229
Practice Address - Fax:912-826-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046877261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care